PELVIC GSW

[Fernando Aguilar]

Thanks for your prompt answer.

We took the patient to the OR and found a pelvic hematoma, non expanding,
but with rupture to peritoneal cavity, about 500 cc hemoperitoneum.  No
lesions to the intraperitoneal rectum.  We explore the hematoma, no vascular
lesions, 500cc of methilen blue via foley without extravasation.
Couln´t do a rectosig transop. because no equip. available (ashame  to say
so), but can see a lesion above the anoscopy, so a colostomy was perform
with distal rectal washout, no presacral drain.  Close cavity with pelvic
open drain.

3 days after surgery large amount of liquid via drain, creatinine 99 (vs.
0.9 seric), Pielogram shows lesion to the distal left ureter.

Tell details of second surgery later.

Dr. Fernando Aguilar
General Surgeon
Calderon Guardia General Hospital
Costa Rica


On 5/23/07, Roy Danks <roydanks at hotmail.com> wrote:
>
> 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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