Indexing Title: OLEYSON’s Medical Anecdotal Report [04-1]

 MAR Title: Packing, the best way for uncontrolled bleeding.

 Date of Medical Observation: December 2003

 Narration:

            A 46 year old female was referred to me last December 2003 with a diagnosis of having a stone in her kidney (nephrolithiasis). I referred the patient to consultant on duty and she was scheduled for an elective nephrectomy.   Intraoperatively, the surgeon whom I assisted, tangentially cut the  renal artery which produced a massive bleeding that is beyond our control. Afterwards, the blood pressure of the patient inevitably went down.  We, then made an immediate request from our anesthesiologist for blood transfusion, however, there were only 2 available blood supply in the blood bank. Because of continuous blood loss we decided to pack the affected area then asked the anesthesiologist to resuscitate the patient until such time that we will be able to refer the patient to our TCVS consultant.  Upon referral to our consultant, I was delighted and with all honesty surprised, when she advised us to just pack the affected area   and re-operate the patient after 48-72 hours. 

            The second operation ended fast, all the bleeders were being controlled and then we did the removal of the gauze pack and closed the abdomen. All eight units of fresh whole blood were transfused in this patient. Practically little of her own was running through her vein. The rest of her stay in the ward was uneventful.  We discharged the patient 10 days after her second operation. 

            This patient felt very happy after her operation. She personally made a follow up every month and gave me cakes and pastries whenever she comes in the hospital.

Insights (Discovery, Stimulus, Reinforcements)

            Through our experience we discovered that with occurrence of continous bleeding in the retroperitoneal area which cannot be controlled, the best way is to pack the area and optimize patient condition and re-operate after 48-72 hours.