A Novel Pneumatic Balloon Saved the Lives of Three Patients With Refractory Pelvic Hemorrhage After Peripartum Hysterectomy

TL;DR

A new pneumatic balloon was used to stop life-threatening pelvic bleeding in three patients after they failed other treatments, offering a promising alternative in emergency obstetric care.

Contribution

The novel pneumatic balloon technique provides a feasible and lifesaving alternative to pelvic towel packing for managing refractory pelvic hemorrhage.

Findings

The pneumatic balloon successfully stopped bleeding in all three patients at a pressure of 40-60 mmHg.

The balloon could be removed at the bedside after 24-72 hours, offering advantages over traditional methods.

The technique is proposed as an emergency tool when other hemorrhage control methods fail.

Abstract

This case report discusses three patients who presented in our obstetric emergency with refractory pelvic hemorrhage following cesarean hysterectomy due to placenta accreta. They were referred from district hospitals with pelvic towel packing as a lifesaving procedure after failure of pelvic angiographic embolization or internal iliac artery ligation. After stabilization, we did a relaparotomy to remove the surgical towels, which led to the recurrence of excessive pelvic hemorrhage. The new pneumatic balloon was prepared from two surgical rubber gloves inserted into each other and ligated around a plastic catheter. The gloves were placed inside the pelvis and then inflated by connecting the air pump of a sphygmomanometer to the catheter outlet. A tight external abdominal binder was applied to keep the balloon in place. The bleeding stopped in all cases when the balloon pressure was calibrated at 40-60 mmHg and kept for 24-72 hours. The balloon was then gradually deflated and removed in a bedside procedure. This pneumatic balloon is a feasible and lifesaving procedure. It can be an alternative emergency tool to towel packing when other methods fail, in terms of the advantages of bedside removal. Large studies are essential to evaluate its efficacy and safety and to estimate the optimum pressure.

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