Hemoabdomen: False negative paracentesis taps can be common - DVM
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Hemoabdomen: False negative paracentesis taps can be common


DVM360 MAGAZINE


At the level of the celiac artery, the surgeon applies enough digital pressure to occlude these vessels. This procedure has been documented to prevent the devastating and often fatal hypotension that results when the tamponade effect of the abdominal distension is relieved.

A suction tip is advanced into the abdomen and the blood is collected into a sterile container for possible autotransfusion. Certainly asepsis is desirable, but even if it cannot be maintained, the blood should not be discarded. In cases where there is no other alternative, autotransfusion of contaminated blood can be lifesaving.

The abdomen is opened to the pubis and packing material is liberally stuffed into the abdomen. Suitable materials include laparotomy sponges, gauze or even towels. Packing the abdomen provides a tamponade effect that helps control hypotension induced by venous dilatation. Packing will often control venous hemorrhage as well. When the packing is in place, the aortic occlusion can be removed.

If the animal is hemorrhaging rapidly in spite of occlusion of the aorta at the level of the celiac artery, a Pringle maneuver should be attempted.

The hepatic artery, the portal vein and the common bile duct are occluded using digital pressure or a tourniquet. Simultaneously, the cranial mesenteric artery is occluded to prevent portal hypertension. This maneuver should be held for 10 minutes. After 10 minutes, the portal occlusion must be released for at least one minute every 10 minutes.

If the source of hemorrhage is found and can be repaired, the repair is accomplished, ancillary procedures are done (j-tube insertion for example) if the animal's condition permits and the abdomen closed.

If the source of the hemorrhage is not readily identified or cannot be readily repaired, the packing is left in the abdomen and the abdomen is closed temporarily using towel clamps, surgical staples, sutures or even safety pins.

The animal can be treated with blood, fluids or whatever is appropriate, and then the abdomen re-explored in 24 to 48 hours when the animal is more stable.


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