- Disadvantages of Laparotomy:
- ligation of specific bleeding vessels in pelvic hematomas may not be technically feasible
- extensive collateral flow of hypogastric system with in pelvis prevents hypogastric artery ligation from being effective;
- ligation of both hypogastric arteries reduces mean arterial pressure in distal arteries by < 25%;
- laparotomy breaches peritoneum, which contains the hematoma;
- w/ laparotomy, extraperitoneal hemorrhage may worsen due to rapid decompression of tamponade;
- in one study there was a 60% mortality rate for laparotomy followed by angiography vs 25% mortality with angiography followed by laparotomy;

- Treatment Options:
- consider preoperative angiography and embolization which may decrease risk of surgery or eliminate need for surgery;
- bilateral hypogastric artery embolization may be effective in controlling blood loss but may lead buttocks ischemia