Volume 11, Issue 1 (2026)
SJMR 2026, 11(1): 37-42 |
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Mir Abootaleb S M, Sanaye Naderi M, Mohammadian H, Ghaharzadeh Mahabadi M. Early Detection of Hemorrhagic Shock in the Recovery Room Following Laparoscopic Ovarian Torsion Surgery and Management with a Massive Transfusion Protocol: A Case Report. SJMR 2026; 11 (1) : 6
URL: http://saremjrm.com/article-1-391-en.html
URL: http://saremjrm.com/article-1-391-en.html
Seyyed Mojtaba Mir Abootaleb *1 
, Maryam Sanaye Naderi2 , Hadis Mohammadian3 , Mostafa Ghaharzadeh Mahabadi4
, Maryam Sanaye Naderi2 , Hadis Mohammadian3 , Mostafa Ghaharzadeh Mahabadi4
1- Sarem Gynecology, Obstetrics and Infertility Research Center, Sarem Women’s Hospital, Iran University
2- Sarem Gynecology, Obstetrics and Infertility Research Center, Sarem Women’s Hospital, Iran University & Sarem Cell Research Center (SCRC), Sarem Women’s Hospital, Tehran, Iran.
3- Sarem Gynecology, Obstetrics and Infertility Research Center, Sarem Women’s Hospital, Iran University of Medical Science (IUMS), Tehran, Iran.
4- Department of Public Administration, Payame Noor University, Tehran, Iran.
2- Sarem Gynecology, Obstetrics and Infertility Research Center, Sarem Women’s Hospital, Iran University & Sarem Cell Research Center (SCRC), Sarem Women’s Hospital, Tehran, Iran.
3- Sarem Gynecology, Obstetrics and Infertility Research Center, Sarem Women’s Hospital, Iran University of Medical Science (IUMS), Tehran, Iran.
4- Department of Public Administration, Payame Noor University, Tehran, Iran.
Abstract: (26 Views)
Background: Hemorrhagic shock is one of the most critical postoperative complications, and when it occurs after laparoscopic procedures, early recognition is essential for survival. In minimally invasive surgeries such as laparoscopic detorsion of the ovary, occult intra‑abdominal bleeding may progress rapidly while initial clinical signs remain subtle, leading to delayed diagnosis. Prompt activation of the Massive Transfusion Protocol (MT), along with coordinated teamwork between anesthesia, surgical staff, and the blood bank, plays a decisive role in preventing multi‑organ failure and mortality.
Case Presentation: A 32‑year‑old woman with no significant past medical history underwent emergency laparoscopic surgery for ovarian torsion. Approximately 30 minutes after the procedure, while preparing for discharge from the recovery room, she developed sudden hypotension and tachycardia. Clinical evaluation suggested hemorrhagic shock, and urgent blood transfusion was initiated. Bedside ultrasonography revealed a large hemoperitoneum. The patient was quickly placed under invasive monitoring, and the Massive Transfusion Protocol was activated. She received a total of 13 units of PRBC, 10 units of platelets, 10 units of FFP, along with fibrinogen, calcium, and albumin. Despite two emergency laparotomies and temporary abdominal packing, the source of bleeding remained unclear. Following hemodynamic stabilization in the ICU, angiography identified a small arterial branch at the laparoscopic port site as the bleeding source, which was subsequently controlled in the final surgical intervention.
Conclusion: This case highlights the importance of vigilant postoperative monitoring in the recovery room after minimally invasive surgery. Sudden onset of hemorrhagic shock, even in initially stable patients, requires rapid and systematic evaluation. Early activation of the Massive Transfusion Protocol, adherence to evidence‑based resuscitation guidelines, advanced hemodynamic monitoring, and close interprofessional collaboration were crucial in achieving a favorable outcome. This case may serve as a practical model for managing acute postoperative hemorrhagic shock following laparoscopic procedures.
Case Presentation: A 32‑year‑old woman with no significant past medical history underwent emergency laparoscopic surgery for ovarian torsion. Approximately 30 minutes after the procedure, while preparing for discharge from the recovery room, she developed sudden hypotension and tachycardia. Clinical evaluation suggested hemorrhagic shock, and urgent blood transfusion was initiated. Bedside ultrasonography revealed a large hemoperitoneum. The patient was quickly placed under invasive monitoring, and the Massive Transfusion Protocol was activated. She received a total of 13 units of PRBC, 10 units of platelets, 10 units of FFP, along with fibrinogen, calcium, and albumin. Despite two emergency laparotomies and temporary abdominal packing, the source of bleeding remained unclear. Following hemodynamic stabilization in the ICU, angiography identified a small arterial branch at the laparoscopic port site as the bleeding source, which was subsequently controlled in the final surgical intervention.
Conclusion: This case highlights the importance of vigilant postoperative monitoring in the recovery room after minimally invasive surgery. Sudden onset of hemorrhagic shock, even in initially stable patients, requires rapid and systematic evaluation. Early activation of the Massive Transfusion Protocol, adherence to evidence‑based resuscitation guidelines, advanced hemodynamic monitoring, and close interprofessional collaboration were crucial in achieving a favorable outcome. This case may serve as a practical model for managing acute postoperative hemorrhagic shock following laparoscopic procedures.
Article number: 6
Keywords: Hemorrhagic Shock, Laparoscopy, Ovarian Torsion, Recovery Room, Massive Transfusion Protocol, Hemodynamic Monitoring
Article Type: Case Report |
Subject:
Women Diseases
Received: 2026/05/10 | Accepted: 2026/05/30 | Published: 2026/06/18
Received: 2026/05/10 | Accepted: 2026/05/30 | Published: 2026/06/18
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