Case Discussions X2
Hardcastle, Tim, Dr <tch at sun.ac.za>
tch at sun.ac.za
Wed Feb 7 10:51:20 GMT 2007
Charles
Interesting suggestion - but we don't use this type of retractor
Tim
-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of charles frosolone
Sent: Wednesday, February 07, 2007 8:05 AM
To: trauma-list at trauma.org
Subject: RE: Case Discussions X2
Tim
Retractor injury? Have seen vigorous or scissoring retractors cause injuries
to bowel. Would be in a place far away from the trauma and would be a clean
cut.
C Frosolone, MD, FACS
>From: "Hardcastle, Tim, Dr <tch at sun.ac.za>" <tch at sun.ac.za>
>Reply-To: "Trauma & Critical Care mailing list"
><trauma-list at trauma.org>
>To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
>Subject: RE: Case Discussions X2
>Date: Wed, 7 Feb 2007 07:05:42 +0200
>
>Ross
>
>Possible, but one would expect more signs of ischaemis colon segment - this
>was a simple 1,5cm hole!
>
>Tim
>
>-----Original Message-----
>From: trauma-list-bounces at trauma.org
>[mailto:trauma-list-bounces at trauma.org]On Behalf Of Dr Ross Hofmeyr
>Sent: Tuesday, February 06, 2007 8:14 PM
>To: 'Trauma & Critical Care mailing list'
>Subject: RE: Case Discussions X2
>
>
>Absolute postulation, but what about a mesenteric artery intimal tear that
>later causes dissection and subsequent thrombotic obstruction?
>
>_________________
>Dr Ross Hofmeyr
>MBChB (Stell) ATLS ACLS
>wildmedic at gmail.com
>ross at wildmedix.com
>www.wildmedix.com
>"Semper Paratus"
>
>-----Original Message-----
>From: trauma-list-bounces at trauma.org
>[mailto:trauma-list-bounces at trauma.org]
>On Behalf Of Kashuk, Jeffry
>Sent: 06 February 2007 07:53 PM
>To: Trauma & Critical Care mailing list
>Subject: RE: Case Discussions X2
>
>Tim,
> I want to comment on case#2..... a few months ago, I had a 50 yo pt
>with a GSW to the left flank area. At exploration, the hematoma was
>fairly extensive and explored. There was extensive muscular bleeding
>from the psoas but no renal, ureter, colon, small bowel, or major
>vascular injury. We had to unroof a fair amt of colon to be sure there
>was no injury but again, good bleeding, intact colon in mid sigmoid
>area. He went home POD 7 on regular diet with nl bowel function only to
>return 3 days later with peritonitis and he also perforated the colon
>area... He healed and went home with his Hartman's procedure.
> I think that in both cases, either we have devascularized the Colon,
>or there was blast injury from either the missile or blunt trauma (in
>your case)that necrosed late... In my case there was not even extensive
>mesenteric hematoma present.. but how could I have predicted this and
>done a resection at the time ? I certainly would have had difficulty not
>exploring and unroofing to be sure there was no injury..
>
>Jeff Kashuk
>Denver,Co
>-----Original Message-----
>From: Hardcastle, Tim, Dr <tch at sun.ac.za> [mailto:tch at sun.ac.za]
>Sent: Monday, February 05, 2007 10:17 PM
>To: Trauma-List (E-mail)
>Subject: Case Discussions X2
>
>Dear all
>
>Just to briefly share 2 interesting cases from the past week or so with
>you.
>
>1) 40-something male, direct blunt abdominal trauma admitted with acute
>abdomen and otherwise stable, early SIRS phase. Taken for laparotomy
>with the following finding: Massive retroperitoneal biloma. Transection
>of piloro-duodenal junction and the thrid part of the duodenum as only
>injuries. D2 and pancreas head intact (CBD looked intact once
>Kocherisation done).
>What we did was a repair of the third part of the duodenum, close the
>first part duopdenal stump and do a B2-type gastro-jejunal anastomosis
>after a segmental gastric resection. He is currently in ICU, but seems
>to be improving.
>
>I would appreciate comment as to what others would have done - have such
>combined injuries been decribed before?
>
>2) 21-y/o corpulent female, MVC passenger - restrained tripod harness,
>seatbelt sign; clinically acute abdomen. At laparotomy decided on by
>clinical basis alone a meter of ischaemic small bowel found and resected
>(mesenteric laceration). Some bruising noted in both paracolic gutters
>but colon macroscopically normal after bilateral mobilisation.Initially
>did fine, but deteriorated on day 6 post-op and we relapped her
>suspecting an anastomotic leak. What we found was wierd! The
>jejuno-ileal anastomosis was intact and looked healing well, but there
>was a blow-out of the mid-decending colon, mesenteric-intraperitoneal
>border, with much fecal contamination that was cleanable. This has been
>defunctioned as a colostomy and mucus fistula. Her abdomen was left open
>with a VAC-pack and the has been retruned after 48 hours for a wash and
>closure She is back in ICU and weaning ventilation and so on.
>
>I have never seen a delayed colon perforation after blunt trauma; small
>bowel - with mesenteric devascularisation yes, but not colon. What is
>even more bizarre is the fact that the team doing the index laparotomy
>looked at the colon and it looked fine! Also the ends bled well after
>minimal debridement, so I'm really not sure why a well perfused colon
>would just perforate??? Unless tehre was a contusion that underwent
>full-thickness necrosis???
>
>Your insight and wisdom awaited.
>
>Tim
>Dr T C Hardcastle
>M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
>Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU) ATLS
>instructor and DSTC Cape Town Course Director Intern program
>Coordinator: Surgery M.Med (Emergency Medicine) Executive Committee
>member Clinical Head (Director): Diana Princess of Wales Trauma Unit
>Division of Surgery (General) Room 4064 Department of Surgical Sciences
>Tygerberg Hospital / University of Stellenbosch PO Box 19063 Tygerberg
>7505 Western Cape South Africa
>e-mail: tch at sun.ac.za
>Cell: +27824681615
>Office: +27219389281 or 4911 pager 0302
>
>
>
>
>
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