El Saman Ali M, Hamed Hossam O
Department of Obstetrics and Gynecology, Assiut University, Assiut, EGY.
Department of Obstetrics and Gynecology, Qassim University, Burraidah, SAU.
Cureus. 2025 May 29;17(5):e85049. doi: 10.7759/cureus.85049. eCollection 2025 May.
This case report discusses three patients who presented in our obstetric emergency with refractory pelvic hemorrhage following cesarean hysterectomy due to placenta accreta. They were referred from district hospitals with pelvic towel packing as a lifesaving procedure after failure of pelvic angiographic embolization or internal iliac artery ligation. After stabilization, we did a relaparotomy to remove the surgical towels, which led to the recurrence of excessive pelvic hemorrhage. The new pneumatic balloon was prepared from two surgical rubber gloves inserted into each other and ligated around a plastic catheter. The gloves were placed inside the pelvis and then inflated by connecting the air pump of a sphygmomanometer to the catheter outlet. A tight external abdominal binder was applied to keep the balloon in place. The bleeding stopped in all cases when the balloon pressure was calibrated at 40-60 mmHg and kept for 24-72 hours. The balloon was then gradually deflated and removed in a bedside procedure. This pneumatic balloon is a feasible and lifesaving procedure. It can be an alternative emergency tool to towel packing when other methods fail, in terms of the advantages of bedside removal. Large studies are essential to evaluate its efficacy and safety and to estimate the optimum pressure.
本病例报告讨论了三名因胎盘植入行剖宫产子宫切除术后在我院产科急诊出现难治性盆腔出血的患者。她们是在盆腔血管造影栓塞术或髂内动脉结扎术失败后，作为挽救生命的措施，从地区医院转诊而来，采用盆腔毛巾填塞法。病情稳定后，我们再次剖腹手术取出手术毛巾，这导致盆腔再次出现大量出血。新型充气气球由两只相互插入并围绕一根塑料导管结扎的手术橡胶手套制成。将手套置于盆腔内，然后通过将血压计的气泵连接到导管出口进行充气。使用紧密的腹部外固定带固定气球位置。当气球压力校准为40 - 60 mmHg并保持24 - 72小时时，所有病例的出血均停止。然后在床边操作中逐渐放气并取出气球。这种充气气球是一种可行的挽救生命的方法。就床边取出的优点而言，当其他方法失败时，它可以作为毛巾填塞法的替代紧急工具。大型研究对于评估其疗效和安全性以及估计最佳压力至关重要。
