GSW to liver

[Errington Thompson]

Yep but your thoughts are still valuable. 

E

Errington C. Thompson, MD, FACS, FCCM
Trauma/Surgical Critical Care
Author - Letter to America
Asheville, NC
-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Tchaka Shepherd
Sent: Monday, December 31, 2007 12:38 AM
To: Trauma & Critical Care mailing list
Subject: RE: GSW to liver


I see I entered this conversation very late.




----------------------------------------
> From: errington at erringtonthompson.com
> To: trauma-list at trauma.org
> Date: Sun, 30 Dec 2007 00:06:51 -0500
> Subject: GSW to liver
> 
> I have a couple of questions on a recent case.  30 yo male was too drunk
to
> have a gun but had one nonetheless.  He shot himself in the right upper
> quadrant.  He was stable, awake and talking in the ER.  Entrance wound
> easily seen just under the ribs and just lateral to the mid-clavicular
line.
> The bullet was palpable just under the skin at about the 12th rib.  No
SOB.
> 
> 
> 1) CT or not CT scan.  IF you do scan the patient and see a thru and thru
> wound the liver, can you just watch him?
> 
> I take the patient to the OR.  He indeed has a thru and thru GSW to the
> liver.  The wounds are not really bleeding.  There is no bile oozing from
> either wound.
> 
> 2) Drain or no drain?
> 
> The patient develops an ileus and bile peritonitis.  He is percutaneously
> drained.  On day 5 with his drain output still over 300 cc per day the
> character of the drainage changes to a dark green.  CT scan revealed an
> abscess posterior to the liver.  Percutaneous drainage was performed.
> Enterococcus in the fluid.  Antibiotics were started.  Antiobiotics
stopped
> after 7 days. 
> 
> Thoughts?
> 
> Errington C. Thompson, MD, FACS, FCCM
> Trauma/Surgical Critical Care
> Mission Hospital
> Asheville, NC
> Author - A Letter to America
> www.whereistheoutrage.net
> 
>  
> Everyone deserves to make an informed decision
>                                 - Errington Thompson, MD
> 
> 
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