Pyloric exclusion

[Juan Duchesne]

 Case: 16 y/o male s/p  MVC unrestrained hypotensive patient with
obvious right leg deformity.......fluid responder per ED.......trauma
team consult after Pan-CT was ordered by ED.........CT of abdomen showed
madness......looked like a  nuclear explosion in his abdomen. There was
positive extravasation from grade 4 liver and spleen with massive
hemoperitoneum. Went for ex-lap. Liver was argon bean and packed, spleen
out, grade 4 pancreas that was drained, grade 2 duodenal injury repaired
drained and TA-60 pyloric exclusion and last but not least common
hepatic artery laceration that was sutured tied and later embolize
secondary to ongoing bleeding.................after damage control
laparotomy went to sicu......long course in SICU (45 days) and now with
open abdomen awaiting STSG and pancreatic fistula. He has not open from
his pyloric exclusion. We tried EGD insufflation already without success
with the hope to stent the pancreatic injury.
Currently on TPN 
Any recs. besides not doing anything and wait?

Thanks
juan

Juan C Duchesne, M.D.
University of Mississippi Medical Center
Assistant Professor of Surgery/Trauma and Critical Care
2500 North State Street
Jackson MS 39216