Pelvic Hemorrhage in Auto Accidents

Pelvic fractures are not uncommon in motor vehicle accidents. Because of the size and nature of these fractures, hemorrhages are likely to happen and these can be fatal. Arterial hemorrhages are the worst injuries from this type of fracture because bleeding can be substantial.

CT scanning can be done to highlight the areas of bleeding and to visualize the fracture. If a pelvic arterial hemorrhage is detected, the doctor can go ahead with an angiographic embolization procedure that clots off the bleeding artery, therefore saving the life of the patient. Contrast material is injected into the pelvic arteries and veins. When the contrast material is seen to extravasate or bleed through the vessel, this is the area that needs to be embolized.

Pelvic hemorrhages can be very dangerous in car accident cases. This type of bleeding causes half of all fatalities in patients with pelvic fractures. In one study, 236 patients were treated following motor vehicle accidents in which they sustained a pelvic fracture. In this study, the average age of patients was 31.5 years. The group was comprised of 2/3 men and 1/3 women. The average Injury Severity Score was 21.3 and, on average, patients required approximately 5 units of blood. A hospital stay averaged almost 17 days.

Most patients in the pelvic hemorrhage study were victims of simple motor vehicle accidents, although 14 percent or 33 patients sustained injuries from a pedestrian motor vehicle accident. A total of 12 patients were victims of motorcycle accidents, some alone and some in conjunction with a motor vehicle. Besides pelvic hemorrhages, other people die from pulmonary emboli, sepsis, multiple organ failure and pulmonary distress.

Those patients who were at higher risk of death had higher injury scores and had fractures in pelvic areas that are more highly associated with bleeding. Fracture displacement was associated with a worsened injury and death. Of the nine people who had to have pelvic arteriography following their fractures, three underwent pelvic arterial or venous embolization to stop actively bleeding pelvic blood vessels. Seven patients had intra-abdominal bleeding that needed an open laparotomy with repair of bleeding vessels.

Of note was that the more severe the pelvic fracture, the greater was the incidence of pelvic hemorrhage. On the other hand, the risk of death was not related to having pelvic hemorrhage but was more related to the presence of other injuries at the same time as the pelvic injury.

One common treatment for pelvic hemorrhage from motor vehicle accidents includes surgical ligation of the hypogastric arteries. This involves making an abdominal incision, locating the hypogastric artery and using clips to close off the artery. The hypogastric artery supplies blood to a great many organs in the pelvis and lower abdomen. It can be used for bleeding in the uterus or other female organs. While it seems to be a drastic procedure where patients are at risk for ischemia in certain areas, it is generally not a problem and the patient can have a lifesaving procedure for pelvic bleeding.

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