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Revisiting Role of Bilateral Ligation of Internal Iliac Arteries and Preperitoneal Pelvic Packing for Hemorrhage Control in Patients with Pelvic Injuries in Resource Constraint Settings

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Abstract

Since the description of bilateral ligation of internal iliac arteries (BLIIA) and preperitoneal pelvic packing (PPP) for hemorrhage control in pelvic injury patients, multiple reports have been published advocating its use with acceptable outcomes. We analyzed our experience with this technique in a setting where the facility of hybrid operating room for simultaneous angioembolization is not available. We analyzed data of sixty-six patients who presented in a state of unresponsive shock with pelvic fracture between January 2014 and September 2019. After initial resuscitation, they all underwent BLIIA with PPP as part of damage control surgery. Out of 66 patients, 55 were male. The mean age was 36.12 years. All patients sustained blunt trauma, with road traffic injuries being the most common mechanism involving 65% of the patients followed by fall from height. The mean systolic blood pressure at the time of surgery was 77 ± 34.46 mm Hg. Median packed red blood cell transfusion in the first 24 h was 8.5 units with IQR of 6–12. The hemorrhage-related mortality was 48%. BLIIA with PPP may be considered as a viable treatment option in hemodynamically unstable patients with pelvic injuries in resource constraint facilities.

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Authors and Affiliations

  1. Division of Trauma Surgery & Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India

    Dinesh Kumar Bagaria, Majid Anwer, Narendra Choudhary, Abhinav Kumar, Pratyusha Priyadarshini, Niladri Banerjee, Junaid Alam, Amit Gupta, Biplab Mishra, Sushma Sagar & Subodh Kumar

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  1. Dinesh Kumar Bagaria
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  2. Majid Anwer
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Correspondence to Subodh Kumar.

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Bagaria, D.K., Anwer, M., Choudhary, N. et al. Revisiting Role of Bilateral Ligation of Internal Iliac Arteries and Preperitoneal Pelvic Packing for Hemorrhage Control in Patients with Pelvic Injuries in Resource Constraint Settings. Indian J Surg 84, 1020–1025 (2022). https://doi.org/10.1007/s12262-021-03210-5

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