Internal Iliac Artery Ligation with Pad Packing for Hemodynamic Unstable Open Comminuted Sacral Fracture

Abstract

A 52-year-old man experienced blunt trauma upon falling from a height of 40 m while trying to repair the elevator. The patient's systolic blood pressure and hemoglobin levels were 60 mmHg and 7.0 g/dL, respectively, upon admission. A large volume of bloody discharge was observed in the open wound of the perianal area and sacrum. A computed tomography scan revealed an open comminuted sacral fracture with multiple contrast blushes. He underwent emergency laparotomy. Both internal iliac artery ligations were performed to control bleeding from the pelvis. Protective sigmoid loop colostomy was performed because of massive injury to the anal sphincters and pelvis. Pad packing was performed for a sacral open wound and perineal wound at the prone position. After resuscitation of massive transfusion, he underwent the second operation 2 days after the first operation. The pad was removed and the perineal and sacral open wounds were closed. After the damage-control surgery, he recovered safely. In this case, the hemodynamically unstable, open comminuted sacral fracture was treated safely by internal iliac artery ligation with pad packing.

Penetrating sacral injury with a metallic pipe: a case report and literature review

“…It also contains complex vascular structures such as the inferior mesenteric artery, the iliac artery originating from the descending aorta, and the venous plexus. A CT scan must be performed with contrast medium to assess the trajectory of the foreign body and injury to the internal organs, major vessels, bony structures, and active bleeding focus [12]. Eight out of 10 of the cases investigated in the literature review involved sustained concomitant organ damage, and the rectum was the most commonly involved intestinal area.…”