Preperitoneal Pelvic Packing: Technique and Outcomes

Abstract Significant pelvic ring fractures are usually secondary to high-energy trauma, and, when associated with other life-threatening injuries and hemodynamic instability, result in high mortality rates ranging from 40-60%. The major cause of death during the first 24 hours after pelvic trauma is attributed to acute blood loss, with later mortality secondary to multisystem organ failure. In a majority of patients, the source of pelvic bleeding is from disruption of the presacral venous plexus and bony fracture sites, while arterial injury is present in only 10-15%. The optimal management algorithm for hemodynamically unstable patients with pelvic fractures remains controversial. The principles of care center on resuscitation, external stabilization of the pelvis, and hemorrhage control with angiography and embolization (AE) and/or preperitoneal pelvic packing (PPP). AE is effective in controlling arterial bleeding in 85-97% of patients, and its role in the management of hemodynamically unstable patients with pelvic fractures is supported in the EAST guidelines. However, since most patients suffer from venous bleeding, PPP can be an alternative life saving technique to control hemorrhage, especially if AE is not immediately available.