An inflated condom as a packing device for control of haemorrhage.

Abstract

Intractable hemorrhaging in the left and right upper quadrants, the pelvic area, and, especially, the liver is an acute, life-threatening condition. Practitioners typically gain control through firm tamponade of the bleeding site with dry laparotomy packs. This approach, however, has many disadvantages. An alternative approach is described and recommended for consideration when intra-abdominal tamponade is required and relaparotomy is not anticipated. A 22-Fr catheter is inserted through a stab wound and a sterile latex condom is ligated proximal to the filled catheter reservoir. The condom is then partially filled with sterile saline and the abdomen closed. After closure, intra-condom pressure is gradually increased to approximately 40 cmH20. The surrounding structures are smoothly covered during expansion and adequate packing is obtained. The balloon is deflated gradually and left in place temporarily after correction of coagulopathy and stabilization of the patient's general condition. Should rebleeding occur, the condom may be reinflated; if not, it is removed. This practice saves lives without obstructing closure of the abdominal wall, losing their tamponading effect once wet, requiring relaparotomy for removal, increasing the risk of would infection and incisional hernia, pack adherence to the wound, and increased risk of intra-abdominal infection associated with using dry laparotomy packs.