[PHISH] Re: PELVIC GSW

[Sanjay Gupta MD]

No CT scan is needed as the patient merits a
laparotomy.  If intraperitoneal rectosigmoid injury
which is easily accessible, patient is hemodynamically
stable (seems to be), came in to the hospital within a
few hours of being shot, I would consider a primary
repair - even if I have to do a segmental resection. 
Look for and fix the bladder, any major vascular
injury etc.  I also still believe in colostomy,
presacral drains and washouts in injuries below
peritoneal resection.  These may or may not help (I
believe they help), but they certainly do not harm.


Sanjay


--- Ronald Simon <Traumamd at nyc.rr.com> wrote:

> I thought rectal washouts were out along with the
> presacral drain?
> ron simon
> 
> Ronald Gross wrote:
> > Looks to me like a rectal/rectosigmoid wound.  I
> would explore, do a
> > rigid sig in the OR, localize the injury, and do a
> colostomy and
> > hartmanns with rectal washout.
> >
> > What did you do, and how did he do?
> >
> > Ron
> > Ronald I. Gross, MD, FACS
> > Associate Director of Traumatology
> > Hartford Hospital
> > Chair, ACS CT Committee on Trauma
> > 80 Seymour Street
> > Hartford, CT  06102
> > 860-545-4187 Phone
> > 860-545-2006 Fax
> > rgross at harthosp.org
> >   
> >>>> "Fernando Aguilar" <draguilarrevelo at gmail.com>
> 05/23/07 7:10 PM >>>
> >>>>         
> > 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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Sanjay Gupta MD
Tel: 412 335 6304


       
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