Benefits of intra-abdominal pack placement for the management of nonmechanical hemorrhage.

Massive nonmechanical bleeding following severe liver injury is a difficult problem. Placement of intra-abdominal packs tamponades this nonmechanical bleeding and allows time for correction of various metabolic disturbances (ie, hypothermia, hypotension, acidosis, and coagulopathy). The purpose of this retrospective study was to evaluate the severity of these metabolic disturbances at the time of pack placement and the sequential improvement. It was found that most life-threatening disturbances that developed during the initial operative procedure could be corrected within 18 hours after pack placement and aggressive resuscitation. We concluded that the onset of nonmechanical bleeding and a coagulopathy marks a grave prognosis for the patient, and consideration should be given at this time for pack placement. Patients can then be aggressively resuscitated and returned to the operating room within 24 hours for pack removal if stability is achieved.