HollowViscusInjuries

- Hollow Viscus Injury The Evil that Lurks Within(the Abdomen Sinai Hospital Dept of Surgery Trauma Conference Case David Hernandez Algorithm

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Unformatted text preview: Hollow Viscus Injury: The Evil that Lurks Within (the Abdomen) Sinai Hospital Dept of Surgery Trauma Conference March 23, 2005 Case: David Hernandez Algorithm: Michele Manahan Management: Dorry Segev Initial Presentation Previously healthy 4 year old boy Seatbelt-restrained MVC passenger 3/2/04 Airway intact, no respiratory distress. Hemodynamically stable. Interactive. No abdominal pain. No n/v. Supraumbilical ecchymosis. Head CT, Abdo CT 3/2 morning - negative. To PICU for observation. Case Presentation Initial Observation Developed fever in PICU. Abd still soft, nondistended, nontender. Tachycardic. Hypoactive bowel sounds. Repeat CT 3/2 evening – free fluid and free air. Case Presentation Operative Findings Exploratory laparotomy. Soiled ascites. Fibrinous exudate on serosal surfaces of bowel. Serosal tear distal ileum, oversewn. 1 cm by 0.7 cm full thickness hole in left colon. Primary repair 4-0 vicryl. Copious irrigation. Primary closure including skin. Returned to PICU. Case Presentation Postoperative ICU Course Profoundly septic. Fluid seeking. Febrile. Vasopressors for 36 hours. Significant abdominal wall erythema. Extubated POD #2. Transferred to floor. Case Presentation Postoperative Course Persistent fevers. Broad spectrum abx. Bowel rest / TPN. Bilious vomiting. CT 3/8 – minimal undrainable fluid collections. Case Presentation Continued Postop Course Vomiting subsided. Diet advanced and tolerated. Defervesced. Abx continued while in hospital. CT 3/12 shown – small loculated abscesses. CT 3/16 not shown – near-complete resolution. Case Presentation The Saga Continues Discharged home POD #14. Well at home for several days, low grade temps. Spiked another fever 4 days after discharge. Seen in ER, tolerating diet, benign abdomen. CT – minimal undrainable collections. Discharged home from ER. Case Presentation Diagnosis Penetrating abdominal trauma Blunt abdominal trauma Diagnostic Workup Indications for Laparotomy Penetrating Abdominal Trauma Diagnosis • Immediately to OR if: • Diffuse abdominal tenderness • No diffuse tenderness but hemodynamically labile without other injuries • No diffuse tenderness, hemodynamically stable, left or right anterior thoracoabdominal injury » Laparoscopy Penetrating Abdominal Trauma Diagnosis • Hemodynamically stable • Observe stab wounds • Consider CT in gun shot wounds and act accordingly • Hemodynamically labile • DPL – If positive, to OR • Resuscitation Blunt Abdominal Trauma Diagnosis • Immediately to OR if: • Diffuse abdominal tenderness Blunt Abdominal Trauma Diagnosis • Hemodynamically stable • FAST (Focused Abdominal Sonogram for Trauma) AND • CT...
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This note was uploaded on 01/12/2012 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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- Hollow Viscus Injury The Evil that Lurks Within(the Abdomen Sinai Hospital Dept of Surgery Trauma Conference Case David Hernandez Algorithm

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