Massive intra‐abdominal bleeding due to injury in the mesenteric artery during late breast reconstruction with a free tram flap: A case report

We report on a rare case of major intra‐abdominal bleeding that occurred in a patient undergoing late breast reconstruction with a transversus rectus abdominis musculocutaneous (TRAM) flap. During the flap‐raising procedure, a small rupture was found at the base of the superior mesenteric artery, pr...

Full description

Saved in:
Bibliographic Details
Published in:Microsurgery 2005, Vol.25 (1), p.57-60
Main Authors: Olsson, E., Svartling, N., Asko‐Seljavaara, S.
Format: Article
Language:English
Subjects:
Abdomen
Biological and medical sciences
Electrocoagulation - adverse effects
Female
Fibrinolysis - physiology
General aspects
Hemorrhage - etiology
Humans
Mammaplasty
Medical sciences
Mesenteric Artery, Superior - injuries
Mesenteric Artery, Superior - surgery
Middle Aged
Rupture
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgical Flaps
Tissue and Organ Harvesting - adverse effects
Citations: Items that this one cites
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:We report on a rare case of major intra‐abdominal bleeding that occurred in a patient undergoing late breast reconstruction with a transversus rectus abdominis musculocutaneous (TRAM) flap. During the flap‐raising procedure, a small rupture was found at the base of the superior mesenteric artery, probably caused by electric current. The ruptured vessel required immediate laparotomy and suturing, and the final outcome of the patient was good. The massive bleeding, almost 8‐fold as compared with three normal cases, caused clear activation of coagulation seen with elevated TAT values at the end of the operation, and remarkably enhanced fibrin turnover with elevated D‐dimer, up to 25‐fold from baseline, on the first postoperative day. As a result of major bleeding, the fibrinolytic system was also activated: a biphasic elevation of tPA was seen, first immediately after the bleeding event at 2 h, and later on the first postoperative day, followed by fibrinolytic shutdown associated with increased PAI‐1 values. © 2004 Wiley‐Liss, Inc. Microsurgery 25:57–60, 2005.
ISSN:0738-1085
1098-2752
DOI:10.1002/micr.20073