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).