DAMAGE CONTROL STRATEGY USING REBOA, DCS, AND DCIR IN A PATIENT WITH ABDOMINAL AND PELVIC TRAUMA

Abstract

　　A 37-year-old man was admitted to our hospital after a traffic accident. He was in hemorrhagic shock due to pelvic fractures. Resuscitative endovascular balloon occlusion of the aorta (REBOA) was performed to control the bleeding. Contrast-enhanced computed tomography revealed intraperitoneal and retroperitoneal hemorrhage. An emergency laparotomy revealed active bleeding from the root of the sigmoid colon mesentery, which was temporarily controlled by compression with gauze. The treatment strategy was changed from laparotomy to transcatheter arterial embolization (TAE) to embolize both internal iliac arteries. After TAE, sigmoid colon resection, rectal resection, and colostomy were performed. The patient underwent further TAE and repeated laparotomy. Finally, he was transferred to another hospital for rehabilitation. A damage control strategy that included REBOA, damage control surgery, and damage control interventional radiology helped manage life-threatening trauma.