Immediate Post-laparotomy Hypotension in Patients with Severe Traumatic Hemoperitoneum
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...
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Korean Society of Traumatology
2020-03-01
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| Series: | Journal of Trauma and Injury |
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| Online Access: | http://www.jtraumainj.org/upload/pdf/jti-2020-014.pdf |
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| author | Gil Jae Lee Min A Lee Byungchul Yoo Youngeun Park Myung Jin Jang Kang Kook Choi |
| author_facet | Gil Jae Lee Min A Lee Byungchul Yoo Youngeun Park Myung Jin Jang Kang Kook Choi |
| author_sort | Gil Jae Lee |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-1cd99c285e324b589df675be1b6b2a4f |
| institution | Kabale University |
| issn | 1738-8767 2287-1683 |
| language | English |
| publishDate | 2020-03-01 |
| publisher | Korean Society of Traumatology |
| record_format | Article |
| series | Journal of Trauma and Injury |
| spelling | doaj-art-1cd99c285e324b589df675be1b6b2a4f2025-02-03T11:12:22ZengKorean Society of TraumatologyJournal of Trauma and Injury1738-87672287-16832020-03-01331384210.20408/jti.2020.0141007Immediate Post-laparotomy Hypotension in Patients with Severe Traumatic HemoperitoneumGil Jae Lee0Min A Lee1Byungchul Yoo2Youngeun Park3Myung Jin Jang4Kang Kook Choi5 Department of Traumatology, Gachon University College of Medicine, Gachon University Gil Medical Center, Incheon, Korea Department of Traumatology, Gachon University College of Medicine, Gachon University Gil Medical Center, Incheon, Korea Department of Traumatology, Gachon University College of Medicine, Gachon University Gil Medical Center, Incheon, Korea Department of Traumatology, Gachon University College of Medicine, Gachon University Gil Medical Center, Incheon, Korea Department of Traumatology, Gachon University College of Medicine, Gachon University Gil Medical Center, Incheon, Korea Department of Traumatology, Gachon University College of Medicine, Gachon University Gil Medical Center, Incheon, KoreaPurpose 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.http://www.jtraumainj.org/upload/pdf/jti-2020-014.pdfhypotensionwounds and injuriesshockintra-abdominal hypertensionhemorrhage |
| spellingShingle | Gil Jae Lee Min A Lee Byungchul Yoo Youngeun Park Myung Jin Jang Kang Kook Choi Immediate Post-laparotomy Hypotension in Patients with Severe Traumatic Hemoperitoneum Journal of Trauma and Injury hypotension wounds and injuries shock intra-abdominal hypertension hemorrhage |
| title | Immediate Post-laparotomy Hypotension in Patients with Severe Traumatic Hemoperitoneum |
| title_full | Immediate Post-laparotomy Hypotension in Patients with Severe Traumatic Hemoperitoneum |
| title_fullStr | Immediate Post-laparotomy Hypotension in Patients with Severe Traumatic Hemoperitoneum |
| title_full_unstemmed | Immediate Post-laparotomy Hypotension in Patients with Severe Traumatic Hemoperitoneum |
| title_short | Immediate Post-laparotomy Hypotension in Patients with Severe Traumatic Hemoperitoneum |
| title_sort | immediate post laparotomy hypotension in patients with severe traumatic hemoperitoneum |
| topic | hypotension wounds and injuries shock intra-abdominal hypertension hemorrhage |
| url | http://www.jtraumainj.org/upload/pdf/jti-2020-014.pdf |
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