Applying damage control principles to a ruptured interstitial pregnancy: a case report of the “pack-and-compress” strategy

Introduction: A ruptured interstitial pregnancy is a critical emergency. When complicated by hemorrhagic shock, a massive accumulation of blood obscures the pelvic anatomy, making immediate surgical repair hazardous. Navigating this blind field carries a significant risk of iatrogenic injuries. We describe a strategic approach to safely regain control of the surgical field before attempting repair. Case presentation: A 31-year-old woman presented with hemorrhagic shock following the rupture of a left interstitial pregnancy. Emergency laparotomy revealed a pelvis filled with approximately 3000 mL of blood, rendering the bleeding site unidentifiable and necessitating extensive hemostasis. Rather than risking blind instrumentation, we prioritized immediate visualization. We packed the upper abdomen to isolate the pelvis and applied digital compression to the infundibulopelvic ligament. This two-step maneuver instantly reduced arterial inflow and cleared the visual field, allowing safe identification and repair of the cornual rupture. Discussion: The application of damage control principles – specifically the “pack-and-compress” technique – provides immediate tactile vascular control and restores anatomical orientation. Conclusion: In hemodynamically unstable patients, prioritizing access-and-control over immediate repair is crucial. The combination of gauze packing and digital vascular control offers a simple and effective strategy for preventing complications in life-threatening gynecological emergencies.