trauma-list Digest, Vol 56, Issue 4

[caesar ursic]

Thanks for all of the suggestions and ideas.  Here's the current situation:

We resected all dead (and it was dead) small bowel, which left him with a
staple line at the ligament of treitz and another staple line at the
ileocecal valve (about 2 cm of terminal ileum remain).  Also a gastrostomy
tube and a tube duodenostomy.  Second look laparotomy 24 hours later
(yesterday) showed no progression of ischemia - i.e. colon looked great, as
does the duodenum.  Abdomen 'closed' with wound-vac.  Will need formal
closure in the next few days.

This morning (two hours ago) he was extubated.  Kidneys working fine
(creatinine slightly up at 1.5 but stable) as are (obviously) his lungs, and
his liver.  Blood pH is normal, serum lactic acid normal.

He says he wants to live.  We are starting TPN.  Family asking about small
intestinal transplant.

CM Ursic
Santa Fe, USA