# Laparotomy, Evacuation of Pelvic Hematoma



## hcg (Feb 3, 2015)

Can anybody please help me with this.

My doctor was urgently called to the OR with a case of intraoperative hemorrhage.

Pre-operative Dx: Intra-abdominal hemorrhage, catastrophic

Description of Operation:
A laparotomy via a low Pfannenstiel incision had been reopened by 2 Drs. There was ongoing acute blood loss from a hemorrhaging uterine artery with a very large broad ligament hematoma.  The previous hysterotomy for cesarean section from the previous evening had been reopened for control of the angles of the hysterotomy.   The whereabouts of the left ureter were unable to be ascertained, but the uterine artery seemed to be high in the uterine wall and this was quickly suture ligated at this point.   There was concern for preservation of fertility, therefore, every effort was made to salvage the uterus.  The broad ligament hematoma was evacuated and the area was inspected on the left.  No other evidence of bleeding could be noted.  Although there was diffuse oozing along the pelvic sidewall likely from the dilutional coagulopathy, as opposed to any discrete large caliber vessel bleeding.  The ovaries were inspected and were within normal limits.   Once we ascertained that hemostasis was complete, a dual layer repair of the hysterotomy with interrupted absorbable sutures, specifically Vicryl, was performed with careful attention to the bladder flap as the hysterotomy was quite low on the lower uterine segment.  The pelvis was thoroughly irrigated and the peritoneal cavity inspected and no other untoward abnormalities were noted.


The patient was hemodynamically stable per the anesthesiologist.   Care of the patient was then returned to the 2 doctors and I exited the operating theater.

Your help is very much appreciated.


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## cynthiabrown (Feb 4, 2015)

was it intra operative? because it says Dr reopened???


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## hcg (Feb 4, 2015)

It was postoperative. Pt had cesarean section a day before they had this surgery.


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## cynthiabrown (Feb 5, 2015)

look at 59350   with78 mod of course ...surture of uterus


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## hcg (Feb 5, 2015)

Awesome! Thank you so much for the help. I appreciate it


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