PELVIC GSW

[Roy Danks]

Looks like extrav from the rectum?  Intra-abd or extra?  I can't tell, looks low.  I had one just like this, though the entry was via the right thigh, traversed the rectum and exited the left hip.  Same thing...stable, benign exam.  I put a scope in...clearly didn't violate the pelvic reflection/peritoneum so I did a diverting loop colostomy (laps assisted)...didn't wash out the rectum or otherwise drain.  Did great.  But, mine was small caliber...prob .22, .32...along those lines.  Did I "luck out"?  Don't know.  I felt it was appropriate.
 
RD



> Date: Wed, 23 May 2007 17:10:36 -0600> From: draguilarrevelo at gmail.com> To: trauma-list at trauma.org> Subject: PELVIC GSW> > I would like to hear your approach to the following case:> Male, 32, gunshot wound to left lateral inferior flank (see picture 01), no> exit wound, arrive ER 20 min. after injury. BP: 120/75, P: 90, SatO2: 98%,> no cristalloids given.> Abdomen tender in lower quadrants. FAST Neg. Rectal: normotonic, feces with> little blood. Pulses: OK.> Abdominopelvic x-ray taken (see picture 02)> CAT Scan shown (pictures 03, 04, 05)> > My hospital is a General Hospital and is one of the 3 mayor hospital at my> country. We manage all trauma patients.> > Dr. Fernando Aguilar> General Surgeon> Calderon Guardia General Hospital> San José, Costa Rica
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