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

• Published in: Microsurgery Vol. 25; no. 1; pp. 57 - 60
• Main Authors: Olsson, E., Svartling, N., Asko‐Seljavaara, S.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 2005; Wiley-Liss
• 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; Human; Anatomical reconstruction; Hemorrhage; Abdomen; Case study; Plasty; Mesenteric artery; Treatment; Surgery; Free flap; Breast; Complication; Musculocutaneous flap; Mammary gland; Lesion; Rectus abdominis muscle
• ISSN: 0738-1085; 1098-2752
• DOI: 10.1002/micr.20073

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.