Department of Orthopaedic Surgery, Daegu Catholic University Hospital, Daegu, Republic of Korea.
Department of Orthopedic and Traumatic Surgery, Cheju Halla General Hospital, Jeju-si, Republic of Korea.
Medicine (Baltimore). 2023 Feb 17;102(7):e32798. doi: 10.1097/MD.0000000000032798.
Retroperitoneal bleedings are the result of injury to parenchymal tissue or vascular structures within retroperitoneal cavity. This may arise spontaneously, as a result of trauma or iatrogenically. Patients usually do not manifest clinically apparent signs and symptoms until a substantial amount of blood loss has occurred. Therefore, it is associated with high morbidity and mortality. Herein we present and discuss a case of fatal iatrogenic retroperitoneal bleeding following open reduction and internal fixation of an unstable pelvic ring injury.
A 66-year-old female patient presented to the Level I regional trauma center with severe pelvic pain after a pedestrian collision by a car.
In initial radiography and computed tomography, she was diagnosed with unstable pelvic ring injury.
Definitive surgery for open reduction and internal fixation through the anterior approach to the sacroiliac joint and anterior intrapelvic approach was performed on the 8th day after the injury.
Patient died 3 days after the surgery due to a massive retroperitoneal bleeding from iliolumbar artery.
Insidious retroperitoneal bleeding from the small vessel may lead to fatal massive retroperitoneal hematoma. Therefore, active retroperitoneal bleeding should be suspected in cases of unexplained unstable hemodynamic status following orthopedic pelvic and acetabular surgery.
腹膜后出血是腹膜后腔内脏器组织或血管结构损伤的结果。这种损伤可能是自发性的，也可能是由于创伤或医源性因素引起的。患者通常在大量失血发生后才会出现明显的临床体征和症状。因此，腹膜后出血与高发病率和死亡率相关。本文介绍并讨论了一例不稳定骨盆环损伤切开复位内固定术后医源性腹膜后出血致死的病例。
一位 66 岁女性患者被车撞倒后出现严重骨盆疼痛，到一级区域创伤中心就诊。
最初的 X 线和 CT 检查诊断为不稳定骨盆环损伤。
在受伤后第 8 天，通过前路骶髂关节和前路骨盆内入路进行确定性切开复位内固定手术。
术后 3 天，患者死于髂腰动脉大出血引起的大量腹膜后出血。
隐匿性小血管腹膜后出血可能导致致命性大量腹膜后血肿。因此，对于骨科骨盆和髋臼手术后不明原因的血流动力学不稳定，应怀疑有腹膜后出血。
