Can pleural packing be an effective solution for uncontrollable intra or post-operative hemorrhage

Authors

  • Hazem Zribi Department of Thoracic and Cardiovascular Surgery, Abderrahmen Mami Hospital, Ariana, Tunisia
  • Abderrahmen Ammar Department of Thoracic and Cardiovascular Surgery, Abderrahmen Mami Hospital, Ariana, Tunisia
  • Amina Abdelkbir Department of Thoracic and Cardiovascular Surgery, Abderrahmen Mami Hospital, Ariana, Tunisia
  • Imen Bouacida Department of Thoracic and Cardiovascular Surgery, Abderrahmen Mami Hospital, Ariana, Tunisia
  • Sarra Maazaoui Department of Thoracic and Cardiovascular Surgery, Abderrahmen Mami Hospital, Ariana, Tunisia
  • Tahar Mestiri Department of Thoracic and Cardiovascular Surgery, Abderrahmen Mami Hospital, Ariana, Tunisia
  • Adel Marghli Department of Thoracic and Cardiovascular Surgery, Abderrahmen Mami Hospital, Ariana, Tunisia

DOI:

https://doi.org/10.18203/2349-2902.isj20202808

Keywords:

Hemostasis, Uncontrollable bleeding, Damage control surgery

Abstract

Background: Uncontrollable bleeding during thoracic surgery has been a challenging problem faced by surgeons. The aim of this study was to clarify the usefulness of pleural packing as a good alternative to control hemorrhage and to deduce the common point between those patients.

Methods: This was a retrospective case series study of eight patients who underwent thoracic surgery with uncontrollable intrathoracic haemorrhage and shock which required intrathoracic packing from January 2014 to December 2019.

Results: During the study period, eight patients underwent thoracic surgery with uncontrollable intrathoracic haemorrhage and needed packing.  Successful hemostasis was achieved in all cases after pleural packing. The mean age was 58.5 years and six patients were males. The common point was the history of pulmonary tuberculosis which was with invasive pulmonary aspergillosis for two patients. Incision was a posterolateral thoracotomy in all cases and six patients required pulmonary resection (five lobectomy and one bilobectomy), one patient required decortication, and one had tumorectomy of a paragonglioma located in the Barety’s space. The unpacking took place right after 48 hours. An arrest of the bleeding was noticed in all the remaining patients. The mean time of the mechanical ventilation was 11 days. Complications included atelectasis and infectious pneumonitis. We noted one case of death.

Conclusions: Intrathoracic packing may be an effective and feasible technique in managing uncontrollable post-operative hemorrhage when the life of patients is in danger. This technique should always be considered for patients with tuberculosis history.

Author Biographies

Hazem Zribi, Department of Thoracic and Cardiovascular Surgery, Abderrahmen Mami Hospital, Ariana, Tunisia

Department of thoracic and cardiovascular surgery

Abderrahmen Ammar, Department of Thoracic and Cardiovascular Surgery, Abderrahmen Mami Hospital, Ariana, Tunisia

department of thoracic and cardiovascular surgery

Amina Abdelkbir, Department of Thoracic and Cardiovascular Surgery, Abderrahmen Mami Hospital, Ariana, Tunisia

Department of thoracic and cardiovascular surgery

Imen Bouacida, Department of Thoracic and Cardiovascular Surgery, Abderrahmen Mami Hospital, Ariana, Tunisia

Department of thoracic and cardiovascular surgery

Sarra Maazaoui, Department of Thoracic and Cardiovascular Surgery, Abderrahmen Mami Hospital, Ariana, Tunisia

Department of pneumology PAV II

Tahar Mestiri, Department of Thoracic and Cardiovascular Surgery, Abderrahmen Mami Hospital, Ariana, Tunisia

Department of anesthesia

Adel Marghli, Department of Thoracic and Cardiovascular Surgery, Abderrahmen Mami Hospital, Ariana, Tunisia

Department of thoracic and cardiovascular surgery

References

Arvieux C, Letoublon C, Reche F. Le damage control en traumatologie abdominale severe. Réanimation. 2007;16(7-8):678‑86.

Voiglio E, Dubuisson V, Massalou D, Baudoin Y, Caillot JL, Letoublon C, et al. Place et technique de la laparotomie ecourtee (LAPEC) OU damage control laparotomy. J Chir Viscerale Aout. 2016;153(4):14‑26.

Feliciano DV, Mattox KL, Jordan GL. Intra-abdominal packing for control of hepatic hemorrhage: a reappraisal. J Trauma. 1981;21:285-90.

Gandolfo BV, Vidarte O, Miller BV, Castillo DM. Prolonged closed liver packing in severe hepatic trauma: experience with 36 patients. J Trauma. 1986;26:754-6.

Feliciano DV, Mattox KL, Burch JM. Packing for control of hepatic hemorrhage. J Trauma. 1986;26:738-43.

Rotondo MF, Schwab CW, Gonigal MD. Damage control: an approach for improved survival in exanguating penetrating abdominal injury. J Trauma. 1993;35:375-82.

Abikhaled JA, Granchi TS, Wall MJ. Prolonged abdominal packing for trauma is associated with increased morbidity and mortality. Am Surg. 1997;63(1):109-1,112.

Alonso PD, Rodriguez SN, Cano JR, Ayub A, Raad W, Alshehri K, et al. Selective packing for uncontrollable traumatic thoracic wall bleeding preserving cardiopulmonary function. Am J Surg. 2016;0(0):31.

Stephan F. Complications postoperatoires de la chirurgie pulmonaire. Reanimation Janv. 2002;11(1):40‑8.

Kilani T, Boudaya MS, Zribi H, Ouerghi S, Marghli A, Mestiri T, et al. Surgery for thoracic tuberculosis. Revue de Pneumologie Clinique. 2015;71(2-3):140-58.

Kohno H, Hisahara M, Umesue M, Matsui K, Ando H, Sakamoto M. Rupture of an infected vein graft in the course of mediastinitis following coronary artery bypass grafting: report of a case. Kyobu Geka. 1990;43:996-9.

Furnary AP, Magovern JA, Simpson KA, Magovern GJ. Prolonged open sternotomy and delayed sternal closure after cardiac operations. Ann Thorac Surg. 1992;54:233-9.

Downloads

Published

2020-06-25

Issue

Section

Original Research Articles