Cases:
The reported patients were referred from secondary care to the Women
Health Hospital, a tertiary care center affiliated with Assiut
University. Admission data indicated that hysterectomy was performed
after failure of conservative options to control severe peri-partum
hemorrhage. The condition was further complicated by severe bleeding
following hysterectomy. Bleeding continued despite various surgical
measures, and eventually pelvic packing using lap sponges was applied.
Nonetheless, trials to remove the lap sponges resulted in recurrent
bleeding, thus re-packing was performed- in each of the three patients-
prior to transfer to our center. Furthermore, two patients underwent
angiographic embolization of pelvic vessels and one had internal iliac
artery ligation, with no success (Table 1). At admission, initial
assessment and hemodynamic stabilization were performed, followed by
patient transfer to the operative theatre. Previously inserted lap
sponges were removed cautiously, one at a time; however, considerable
bleeding was invariably observed in the three patients. Bleeding
originated from the friable pelvic side wall tissue, vaginal vault, and
traumatized tissue by previous surgical maneuvers. Stitches were taken
to achieve hemostasis; however, bleeding was only stopped by
re-application of the sponge compression, which we replaced with the
glove tamponade. We found that an intra-glove pressure between 40-60
mmHg was most effective to achieve and maintain hemostasis. A deflation
test was conducted 24-48 hours afterwards; two patients did not show
further bleeding. The drain of the third patient showed fresh bleeding
upon deflation. Accordingly, the balloon was re-inflated for additional
24 hours. Thereafter, the balloon was deflated but left in place for 24
hours as a backup plan in case of recurrent bleeding. Once hemostasis
was ensured, the tamponade was finally removed. The total duration of
the procedure declined from 75 minutes in the first patient to 35
minutes in the third patient. Two patients had uncomplicated
postoperative course, while one had a superficial wound infection (Table
2).