Immediate Post-laparotomy Hypotension in Patients with Severe Traumatic HemoperitoneumImmediate Post-laparotomy Hypotension in Patients with Severe Traumatic Hemoperitoneum
- Other Titles
- Immediate Post-laparotomy Hypotension in Patients with Severe Traumatic Hemoperitoneum
- Authors
- Gil Jae Lee; Min A Lee; Byungchul Yoo; Youngeun Park; Myung Jin Jang; Kang Kook Choi
- Issue Date
- Mar-2020
- Publisher
- 대한외상학회
- Keywords
- Hypotension; Wounds and injuries; Shock; Intra-abdominal hypertension; Hemorrhage
- Citation
- 대한외상학회지, v.33, no.1, pp.38 - 42
- Journal Title
- 대한외상학회지
- Volume
- 33
- Number
- 1
- Start Page
- 38
- End Page
- 42
- URI
- https://scholarworks.bwise.kr/gachon/handle/2020.sw.gachon/27647
- ISSN
- 1738-8767
- Abstract
- Purpose: Immediate post-laparotomy hypotension (PLH) is a precipitous drop in blood pressure caused by a sudden release of abdominal tamponade after laparotomy in cases of severe hemoperitoneum. The effect of laparotomy on blood pressure in patients with significant hemoperitoneum is unknown.
Methods: In total, 163 patients underwent laparotomy for trauma from January 1, 2013 to December 31, 2015. Exclusion criteria included the following: negative laparotomy, only a hollow viscous injury, and hemoperitoneum <1,000 mL. After applying those criteria, 62 patients were enrolled in this retrospective review. PLH was defined as a decrease in the mean arterial pressure (MAP) ≥10 mmHg within 10 minutes after laparotomy.
Results: The mean estimated hemoperitoneum was 3,516 mL. The incidence of PLH was 23% (14 of 62 patients). The MAP did not show significant differences before and after laparotomy (5 minutes post-laparotomy, 67.5±16.5 vs. 68.3±18.8 mmHg; p=0.7; 10 minutes post-laparotomy, 67.5±16.5 vs. 70.4±18.8 mmHg; p=0.193). The overall in-hospital mortality was 24% (15 of 62 patients). Mortality was not significantly higher in the PLH group (two of 14 [14.3%] vs. 13 of 48 [27.1%]; p=0.33). No statistically significant between-group differences were observed in the intensive care unit and hospital stay.
Conclusions: PLH may be less frequent and less devastating than it is often considered.
Surgical hemostasis during laparotomy is important. Laparotomy with adequate resuscitation may explain the equivalent outcomes in the two groups.
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