When: blunt pelvic trauma with hemodynamic instability.

How:

1. Low vertical midline incision, stop a short distance below the umbilicus.

2. Split rectus, retract laterally, the peritoneum is just behind the rectus.

3. Slide hand directly under the rectus- palm toward peritoneum and back of your hand toward rectus. Bluntly dissect laterally toward ASIS.

4. Retract rectus anteriorly, use your other hand to place rolled laps in the potential space you just developed

[This how-to guide was designed in response to a query from @obcast]

References

1. Smith WR et al. Retroperitoneal packing as a resuscitation technique for hemodynamically unstable patients with pelvic fractures: report of two representative cases and a description of technique. J Trauma. 2005 Dec;59(6):1510-4

2. Filiberto DM and Fox AD. Preperitoneal pelvic packing: Technique and outcomes. Int J Surg. 2016 Sep;33(Pt B):222-224.