skip to main content

Concurrent intra-abdominal and pelvic haemorrhage after blunt trauma — MRCEM SBA MCQ

Instant feedback + full explanation. One question, done properly.

HardResuscitation and critical illnessConcurrent intra-abdominal and pelvic haemorrhage after blunt traumaMRCEM SBA

A 37-year-old man is brought to a major trauma centre after a high-speed road collision. He initially responds to blood product resuscitation and undergoes CT, which shows a splenic laceration with active contrast extravasation and substantial intraperitoneal blood, as well as a pelvic fracture with active arterial bleeding. A pelvic binder is in place, intravenous tranexamic acid has been given, and the major haemorrhage protocol is running. On return from CT his blood pressure falls to 72/40 mmHg and remains low despite further red cells and plasma. There is no evidence of significant thoracic haemorrhage. An operating theatre and interventional radiology are both immediately available. Which haemorrhage-control strategy is most appropriate now?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Proceed to damage-control laparotomy with pelvic packing.

This patient has two demonstrated sources of major haemorrhage and is now haemodynamically unstable despite ongoing blood product resuscitation. The splenic injury, substantial intraperitoneal blood and failure to respond make immediate abdominal haemorrhage control the priority. NICE recommends damage-control surgery for instability that does not respond to resuscitation. Crucially, when an emergency laparotomy is needed for abdominal injuries **and** there is active arterial pelvic bleeding, NICE specifies pelvic packing as the first-line invasive pelvic treatment. Damage-control laparotomy with pelvic packing therefore addresses both threats without delaying abdominal surgery. ([nice.org.uk](https://www.nice.org.uk/guidance/ng39/chapter/Recommendations)) A is attractive because embolisation is ordinarily first-line for active arterial pelvic bleeding, but not when another injury requires emergency laparotomy. C could be considered in a patient sufficiently stable for interventional treatment of both sites; this patient is not. D would delay haemorrhage control for imaging when CT has already identified the injuries and the patient is no longer responding to resuscitation. E correctly prioritises laparotomy but defers initial pelvic haemorrhage control: pelvic packing can be performed during the operation, with further intervention considered according to the subsequent course. ([nice.org.uk](https://www.nice.org.uk/guidance/ng39/chapter/Recommendations))

Reference: NICE NG37, Fractures (complex): assessment and management, recommendation 1.2.16 (2016) — https://www.nice.org.uk/guidance/ng37/chapter/recommendations NICE NG39, Major trauma: assessment and initial management, recommendations 1.5.29, 1.5.37 and 1.5.40 (2016) — https://www.nice.org.uk/guidance/ng39/chapter/Recommendations