Ref:Re: total small bowel infarction

[josemaya01]

Sounds easy, unfortunately most facilities don´t have that much availability of resources.
José Mayagoitia M.D., FACS
Hospital General de Mexicali, México


De : "Ben Reynolds" aneurysm_42 at yahoo.com
Para : "Trauma & Critical Care mailing list" trauma-list at trauma.org
Copia : 
Fecha : Sat, 2 Feb 2008 11:53:52 -0800 (PST)
Asunto : Re: total small bowel infarction


> When reading below understand that my approach is predicated on the availability of particular premium resource at my institution (namely Kareem Abu-Elmagd).
> 
> 1. Resect enbloc and temporary closure
> 2. Second look, resect more if necessary, third look if necessary then create end ostomies
> 3. TPN
> 4. Multivisceral transplant when stable.
> 
> We have had a successful outcome using that algorithm with just the patient you described. 
> 
> Ben Reynolds, PA-C
> Pittsburgh, PA
> 
> ----- Original Message ----
> From: caesar ursic 
> To: "Trauma &, Critical Care mailing list" 
> Sent: Friday, February 1, 2008 7:30:03 PM
> Subject: total small bowel infarction
> 
> 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
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