Total Small Bowel Infarction

[Matthew Reeds]

Caesar,

 

The chances of this man leaving hospital following a total small bowel
resection, surviving the peri & post-operative recovery, not succumbing to
another MI, renal failure, being able to wean from a ventilator etc. are
negligible to none. Even then, he would require lifelong TPN which, although
possible, has its own complications and problems as well as lifestyle
issues.

 

I don't know what his previous lifestyle and function was like, but I
presume that it wasn't good given his medical co-morbidities. Best thing
would be to close him up, setup a morphine infusion and keep him
comfortable. I have seen some heroics attempted with these patients and they
rarely, if ever, work (they need to be young fit healthy patients with large
physiological reserves capable of undergoing the procedure and the insults
that they are subjected to as part of their recovery process.) This patient
unfortunately does not sound as if he would pass this test.

 

Regards,

 

Matthew

 

____________________________________________________________________________
________________________

caesar ursic cmursic at gmail.com
<mailto:trauma-list%40trauma.org?Subject=total%20small%20bowel%20infarction&
In-Reply-To=> 
Sat Feb 2 00:30:03 GMT 2008

 

60 y.o male vasculopath (multiple prior myocardial infarctions, peripheral

vascular reconstructions, etc) s/p blunt abdominal trauma and repair of mid

small bowel blow-out injury (seatbelt injury).  Did well post-op, discharged

home.  Re-presents three weeks later with sudden onset abdominal pain.

Re-explored.  Entire small intestine infarcted, from ligament of Treitz to

ileocecal valve.

 

Therapeutic options?    Close abdomen, morphine drip, game over

or....resect, drain, support, hope he can be nourished parenterally if he

makes it to ICU.

 

What's the survival rate for total loss of small bowel in this age group?

 

Cordially, etc.

 

CM Ursic, MD

Santa Fe, USA