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Malignant Disease:
Special Procedures

Staging of Gynecologic
Oncology Patients With
Exploratory Laparotomy

Subclavian Port-A-Cath 

Peritoneal Port-A-Cath

Application of Vaginal
Cylinders for Intracavitary
Radiation Therapy

Application of Uterine Afterloading Applicators
for Intracavitary Radiation Therapy  

Pelvic High-Dose Afterloader

Abdominal Injection of Chromic Phosphate

Supracolic Total Omentectomy

Omental Pedicle "J" Flap

Tube Gastrostomy

Total Vaginectomy

Radical Vulvectomy
With Bilateral Inguinal
Lymph Node Dissection

Reconstruction of the
Vulva With Gracilis Myocutaneous Flaps

Transverse Rectus
Abdominis Myocutaneous
Flap and Vertical Rectus
Abdominis Myocutaneous

Radical Wertheim
Hysterectomy With
Bilateral Pelvic Lymph
Node Dissection and With Extension of the Vagina

Anterior Exenteration

Posterior Exenteration

Total Pelvic Exenteration

Colonic "J" Pouch Rectal

Kock Pouch Continent Urostomy

Omental "J" Flap Neovagina

Ileocolic Continent Urostomy (Miami Pouch)

Construction of Neoanus
Gracilis Dynamic Anal

Skin-Stretching System Versus Skin Grafting

Gastric Pelvic Flap for
Augmentation of Continent Urostomy or Neovagina

Control of Hemorrhage in Gynecologic Surgery

Repair of the Punctured
Vena Cava

Ligation of a Lacerated
Internal Iliac Vein and
Suturing of a Lacerated Common Iliac Artery

Hemorrhage Control in
Sacrospinous Ligament
Suspension of the Vagina

Presacral Space
Hemorrhage Control

What Not to Do in Case of Pelvic Hemorrhage

Packing for Hemorrhage

Control of Hemorrhage
Associated With Abdominal Pregnancy

Control of Hemorrhage Associated
With Abdominal Pregnancy

Control of hemorrhage associated with abdominal pregnancy is an important technique in obstetrical care. Every labor or delivery room should have a protocol as to the management of abdominal pregnancy. There are several available protocols, but none is perfect, and all have sequelae and long-term complications.


In this patient, the fetus shows multiple placental attachments to the mesentery of the descending colon. In this patient also, the placentae are attached in one particular area. Placentae can be attached all over the abdomen, however, from the liver to the pelvis. Each of these placentae has its own blood supply.

Several of the placentae have been dislodged and torn away from the attachments. Profuse hemorrhage results. Individual clamping or ligating of these hemorrhaging sites is frequently impossible. The most efficacious management of this problem is to clamp the main umbilical cord immediately adjacent to the fetus, remove the fetus, and pack off the bleeding sites with large abdominal packs, sterile sheets, or whatever available.

If the hemorrhage cannot be controlled with the usual techniques and the patient has lost more then 5000 mL of blood, hypovolemic shock will result. The most efficacious procedure in this situation consists of packing the pelvis, admission of the patient to the surgical intensive care unit, and return of the patient to the operating room in 48 hours. The rectus fascia should not be closed; the skin should be closed with towel clips.

In 48 hours, she can be returned to the operating room with the proper vascular surgery team and instruments. The towel clips can be removed from the skin, the abdomen can be opened, packing can be removed, and in most cases, the hemorrhage is contained. Occasionally, small bleeding points can be oversewn or overligated.


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