NOt true trauma but a cool abdo case

[Nicholas Macartney]

Sounds very like a case we had last week. Colon perf by scope ( done  
at central london teaching hospital ). In your case I would have  
waited for the surgeon to come in, and not tried to decompress.  
Afterall, she now has the gas in the abdomen so the laparoscopy has  
started <g>
Nick
On 15 Mar 2008, at 17:12, Andrew J Bowman wrote:

> 55 year old female. PMH of L1 paraplegia from fall off roof 20 years  
> ago,
> paranoid schizophrenia.
>
> Had colonoscopy 2 days prior to ER visit for evaluation of "blood on  
> tissue
> paper".
> Patient does not know details of procedure. (biopsy, problems, etc)
> Presents with 2 days of increasing abdominal pain, bloating, nausea,
> anorexia and dyspnea and decreased urine output.
>
> Has not called her doctor or her GI doctor.
>
> I find her to be awake and alert. Tachypneic at 32, pulse 120-130,  
> BP 84/60.
> Abdomen rounded, bloated, firm, diffusely tender and has loud  
> tympany to
> percussion. Foley placed with
> 50ml urine returned. Breath sounds clear and equal, ? slightly  
> diminished.
>
> Fluid resuscitation started with NS. Stat acute abdomen series.
>
> Marked amount of free air with elevated diaphragm and downward and  
> medially
> displaced liver. Double colon wall sign noted.
>
> BP came up with fluids. Still tachypneic but maintaining sats with  
> nasal O2
> at 4lpm.
> Creatinine 2.5.
>
> I called surgeon and he came in about 45 minutes after call and off  
> to the
> OR about 30 minutes later (team is on call for this small community
> hospital). BP labile in ER waiting for surgeon. As low as mid-80's  
> and as
> high as 110 systolic. Heart rate always 110-120.
>
> Nice tension pneumoperitoneum with presumed abdominal compartment  
> syndrome.
>
> Should I have done a bedside decompression with a DPL catheter???
>
>
> Andrew
>
> I will have images to share by Tuesday am (if the computer Gods are  
> smiling)
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