Hemostatic Matrix for Managing Pediatric Vaginal Trauma Subsequent to Straddle Injury

Abstract

Abstract

Background: Hemostatic agents are most commonly used in surgery as an adjunct to control bleeding, but are similarly efficacious in controlling nonoperative hemorrhage. Conventional approaches to vaginal laceration repair can be difficult in young children because of poor visualization and patient discomfort, often requiring a general anesthetic. Exploration can reopen or extend a laceration, leading to additional trauma and hemorrhage. The first known reported case of nonoperative use of a hemostatic matrix in management of a pediatric vaginal laceration is presented. Case: A 2-year-old female, after sustaining a straddle injury, presented with a source of vaginal bleeding that could not be thoroughly visualized. This fall injury, witnessed by the parents, was consistent with nonpenetrating blunt force trauma. Her hemoglobin decreased from 12.1 to 9.7 g/dL. She was discharged initially after the bleeding stopped, but presented a second time with blood trickling again from the vagina. Hemostatic matrix was topically introduced into the vagina in an atraumatic fashion using the applicator tip. Results: Rapid and sustained hemostasis was achieved with minimal discomfort to the patient, thus avoiding surgical exploration. She had an uneventful hospital course and at her 2-month follow-up, she had no anemia, residual bleeding, discomfort, or complications. Conclusions: Hemostatic matrix as a treatment in certain children with active bleeding following vaginal trauma can be useful for hemostasis. Patients considered for this treatment must be at low risk for penetrating injury and peritoneal entry. In this case, unnecessary surgical intervention was avoided. (J GYNECOL SURG 29:257)