Delayed oesophageal injury

[Wilson, Matthew, M.D.]

Clearly the debate here is the 16 hour delay to repair.  I agree with
Dr. McSwain.  Primary repair with a flap for additional coverage.  NPO,
ABX and no feeding tubes or drain.  Skin left open with BID packing.
Swallow before refeeding.  

If this repair does not work, now the fun will truly begin and the
multiplicity of  options need to then be considered.

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of McSwain, Norman E
Jr.
Sent: Thursday, May 29, 2008 12:33 PM
To: Trauma & Critical Care mailing list
Subject: RE: Delayed oesophageal injury

I would have closed the injury, pulled muscle over the areas of repair
and WOULD NOT have place any drains. Drains create fistulae. Muscle
provides sealing coverage.  NPO x 48 hours of antibiotics. IV fluids.
Esophageal swallow to access the repair in 48-72 hours.

This is assuming a standard sized stab wound < 2 cm on each side and no
vascular injury

I would not have created a spit fistula nor a jejunostomy

I would have treated a GSW the same way unless massive tissue
destruction

Norman
 
Norman McSwain MD
Professor, Tulane School of Medicine
Trauma Director, Charity Hospital Trauma Center
norman.mcswain at tulane.edu
504 988 5111

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Ranjith Ellawala
Sent: Thursday, May 29, 2008 12:13 PM
To: Trauma &amp, Critical Care mailing list
Subject: Delayed oesophageal injury

Young male with a stab in from left side of neck, penetrating both
walls. presenting 16hrs after the injury. My colleague performed surgery
which involves mobilizing oesophagus onto the surface on left , keeping
the proximal part as a fistula , applying a pursestring suture to distal
opening. The wound was infected at the time of surgery. Additional
feeding jejunostomy was performed as well
  Please let me know how you deal with this situation ?
  Dr.Ranjith Ellawala
  Consultant Surgeon
  Trauma Unit,
  The National Hospital of Sri lanka
  Colombo
  Sri lanka

 Send instant messages to your online friends
http://uk.messenger.yahoo.com 
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/
IMPORTANT WARNING: This message is intended for the use of the person or entity to which it is addressed and may contain information that is privileged and confidential, the disclosure of which is governed by
applicable law.  If the reader of this message is not the intended recipient, or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this information is STRICTLY PROHIBITED.

If you have received this message in error, please notify us immediately
by calling (310) 423-6428 and destroy the related message.  Thank You for your cooperation.