Ref:Total Small Bowel Infarction

[josemaya01]

Totally in accord with Matthew, even if he is able to withstand resection, post op will be like hell, and even if he makes it at this point his quality of life will be severely affected, and his chances of survival beyond six months are grim.
José Mayagoitia M.D. FACS
ICU trauma surgeon,Hospital General Mexicali, México


De : "Matthew Reeds" mgreeds at reeds.uk.com
Para : "Trauma & Critical Care mailing list" trauma-list at trauma.org
Copia : 
Fecha : Sat, 2 Feb 2008 10:30:26 -0000
Asunto : Total Small Bowel Infarction


> 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
> 
> 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
> 
>