GSW to liver

Wed Jan 2 17:53:35 GMT 2008

I have a modest experience with 2 recent cases of penetrating injuries to
the liver with continuous bile leak. One of them had a leak through the
diaphragm into a chest tube and the other developed a bile leak after the
laparotomy when a JP drain was left near a non bleeding laceration. In both
cases an ERCP and stenting the papilla immediately decreased the output by
60% and the leak stopped spontaneously a week later. There were no
complications from the procedure.

P.S. Octreotide usually decreases the bile output by 30%

Good luck,

Haim Paran

Kfar-Sava

Israel

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Errington Thompson
Sent: Wednesday, January 02, 2008 1:03 AM
To: 'Trauma &amp; Critical Care mailing list'
Subject: RE: GSW to liver

Peter - 

You might be right but as I'm looking at a patient who is post-injury day 32

(on going biliary drainage), I'm thinking a stent maybe helpful. 

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

-----Original Message-----

From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]

On Behalf Of Peter

Sent: Tuesday, January 01, 2008 5:02 PM

To: 'Trauma &amp; Critical Care mailing list'

Subject: R: GSW to liver

I think that the placement of a stent  does nothing to improve drainage in

this case, but is an invasive procedure with a possibility of increasing the

risk of infection. The biliary output will decrease spontaneously.

Peter

-----Messaggio originale-----

Da: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]

Per conto di Tchaka Shepherd

Inviato: lunedì 31 dicembre 2007 6.27

A: Trauma &amp; Critical Care mailing list

Oggetto: RE: GSW to liver

If the patient remains stable. ERCP with stent placement should provide a

path of least resistance and significantly decrease your drain output.

Isolated liver injuries with hemodynamic stability infrequently need

operative intervention.

----------------------------------------

> From: jamac at pacific.net.ph

> To: trauma-list at trauma.org

> Date: Thu, 11 Dec 2003 18:17:25 +0800

> Subject: Re: GSW to liver

> 

> Dr. Thompson,

> I will also take the patient to the OR. Seeing the extent of his injury, I

> will place a balloon tamponade and drain.

> Thanks.

> Joel U. Macalino, MD

> Philippines

> ----- Original Message -----

> From: Errington Thompson 

> To: 'Trauma & Critical Care mailing list' 

> Sent: Sunday, December 30, 2007 1:06 PM

> 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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