Qasim Z A, Masood R, Mateen M A.
Successful use of Angiographic Embolization to control Hemorrhage from Blunt Pelvic Trauma in a Pediatric Patient.
J Pak Med Assoc Jan ;54(1):32-3.

A 10-year-old boy, involved in a motor vehicle accident was transferred to our Emergency Department. On arrival, he was in grade III shock. Examination revealed a distended abdomen, with bruising over the suprapubic region and blood at the urethral meatus. Both lower extremities showed extensive abrasions. He was immediately resuscitated and intubated in accordance with established advanced trauma life support (ATLS) protocols. Initial x-rays demonstrated extensive pelvic and lower limb fractures involving the right sacroiliac joint, right acetabular fracture, right pubic rami, right femur, and right tibia and fibula. As he remained hypotensive and tachycardic despite fluid resuscitation, and no other obvious bleeding site was found, he was taken to the operating room for abdominal exploration. Laparotomy revealed 500 milliliters of blood in the peritoneal cavity, no solid or hollow viscus injury, presence of massive retroperitoneal hematomas, and a distended and contused urinary bladder. Suprapubic tube cystostomy was performed, and external fixators were applied to the right leg. Postoperatively in the intensive care unit, the child remained hemodynamically unstable and required massive blood transfusion. Angiography was performed 17 hours after surgery, which showed contrast extravasation from branches of the right internal pudendal artery. These bleeding points were successfully embolized using 2mm x 2.5mm platinum coils (Trufill-Cordis, USA) and Poly vinyl alcohol particles (Cordis, USA ). The child`s condition improved following angioembolization. The remainder of his hospital stay was unremarkable, and he was discharged home, with close follow-up and rehabilitation in the outpatient clinic. He has remained well and is awaiting delayed repair of his urethral injury.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com