Control of presacral hemorrhage after penetrating trauma: a new technique

Exsanguinating hemorrhage from coccygeal fracture dislocation: First report of a life-threatening injury

Background: Penetrating injuries to sacrum are rare; only a few reports have been published in literature. We hereby report the first case of low velocity penetrating trauma leading to coccygeal fracture dislocation and exsanguination, without any major abdominal/vascular injury. Case Report: The patient underwent wound packing bedside and hemostatic resuscitation. Wound packing was successful in achieving hemostasis. He stabilized after 1.5 L of fluids, massive hemorrhage protocol institution (12-unit blood components), and vasopressor support. The presentation is unique and not reported in literature published so far. Conclusion: This report is a pertinent example of lifesaving potential of effective wound packing, which is often under-utilized. Possibility of associated neurological injury and residual foreign bodies is there in such cases. They should be duly assessed after stabilizing life-threatening injuries.

Application of an external fixator vascular compressor (EFVC) in the critically injured trauma patient: a novel damage control technique

Methods of controlling hemorrhage in penetrating abdominal injuries are varied, ranging from electrocautery, ligation, laparotomy sponge packing, angiography, hemostatic agents, and direct manual pressure. Unfortunately, traditional methods are sometimes unsuccessful due to the location or nature of the hemorrhage, and manual pressure cannot be held indefinitely. We describe a novel damage control technique for hemorrhage control in these situations, followed by three cases where an external fixator vascular compressor (EFVC) was used to hold continual pressure. Three patients are presented to a Level 1 trauma center following multiple ballistic injuries, all requiring emergent exploratory laparotomy. The first had a two-pin iliac crest EFVC placed during repeat exploratory laparotomy to control bleeding. The second patient had a supra-acetabular EFVC placed during initial exploratory laparotomy after emergent embolization failed to control bleeding from the L3 vertebral body. The third patient had a two-pin iliac crest EFVC placed at initial exploratory laparotomy due to uncontrollable bleeding from the sacral venous plexus and internal iliac veins. Of the three patients, two stabilized and survived, while one passed away due to multi-organ failure. We describe a novel damage control technique that may be a useful means of temporarily stemming intraabdominal bleeding that is otherwise recalcitrant to traditional hemostatic methods. Additionally, we provided a limited case series of patients who have undergone this technique to illustrate its utility and versatility. This technique is simple, fast, effective, and adaptable to a variety of circumstances that may be encountered in patients with intraabdominal bleeding recalcitrant to conventional hemorrhage control.