A Case with Traumatic Massive Bleeding from the Middle Colic Vein and Left Gastro-Epiploic Artery Successfully Treated with a Combination of Damage Control Surgery and Transcatheter Arterial Embolization

Abstract

We herein report on a patient with traumatic massive bleeding from the middle colic vein and left gastro-epiploic artery who was successfully treated with a combination of damage control surgery and transcatheter arterial embolization (TACE). A 58-year-old male who had fallen from the top of a ladder was admitted to our hospital and was diagnosed with computed tomography as having massive abdominal bleeding. An emergency laparotomy after proper resuscitation revealed a complex injury near the root of superior mesenteric vein which was unable to be repaired completely at the initial operation. Temporary hemostasis was performed with local gauze packing. Three hours after the operation, massive intra-abdominal arterial re-bleeding occurred. Following a emergency conference among surgeons, intensive care specialists and radiologists, the bleeding from the left gastro-epicolic artery was successfully and temporally controlled with TACE by radiologists under systemic management by the intensive care specialists. Thirty six hours later, complete hemostasis was achieved by fixing both the middle colic vein and left gastro-epiploic artery with a surgical maneuver. The patient gradually recovered from renal failure and pneumonia during a 22-day stay in the intensive care unit. Cross-speciality medical care is essential for the treatment of patients with a complex injury.