Review Question - QID 219117

A 72-year-old male presents as a level I trauma patient after being involved in a head-on motor vehicle collision. He is resuscitated with 2 units of blood and platelets per mass transfusion protocol. The radiographs of his chest and cervical spine reveal no gross abnormalities. Figure A shows his pelvis radiograph after being placed in an appropriately applied pelvic binder. He is found to have a positive FAST examination and proceeds emergently for an exploratory laparotomy, resulting in the trauma team performing a splenectomy. No other intra-abdominal injuries are found. While the patient is less unstable over the next 72 hours, he continues to require multiple units of blood with gradually decreasing hemoglobin levels, unresolved hypotension, and persistent tachycardia. Furthermore, his lactate remains >5.0 mmol/L and pH remains near 7.1. An updated pelvic CT scan shows hemoperitoneum, minimal fluid tracking through the bilateral paracolic gutters, and an enlarging hematoma near the base of the corpus cavernosum (Figure B). There is no appreciable fluid extravasation near the splenectomy site. Which of the following is the most appropriate next step in management?