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Sun, 6 Apr 2003 22:05:15 -0500

Others have covered the major points.

In this patient. Fix the bleeding.  Control contamination and place a
temporary closure.  Return to the OR when the patient is euvolemic and warm.

E

Errington C. Thompson, MD, FACS Trauma Surgeon Trinity Mother Frances Tyler,
Tx. ecthompson@tyler.net Don't think you are Know you are   - Morpheus (The
Matrix)

----- Original Message -----
From: "azonic75" <azonic75@yahoo.com>
To: <trauma-list@trauma.org>
Sent: Saturday, April 05, 2003 8:39 PM
Subject: GSW to abdomen

> Would like some feedback/wisdom/criticism regarding a
> recent case....
>
> 26 y/o male presents with multiple GSW, one to the
> left chest mid axillary line 9th ICS, another on the
> left just below the costal margin. Combative in ED,
> intubated, left chest tube placed with minimal output,
> HR 140, SBP 60. Taken to OR where laparotomy reveals
> ~2L blood in belly, 6 SB enterotomies, enterotomy in
> transverse colon near the splenic flexture, injury to
> distal left iliac vein and artery and diaphragmatic
> injury.
>
> We performed a colonic resection with ostomy, resected
> the area of SB with the enterotomies (~2 feet) and
> made one anastomosis. Iliac injuries were repaired
> after  obtaining proximal control at the aorta and
> distally with compression
>
> As expected pt became cold, acidotic, coagulopathic
> and eventually arrested
>
> What may have been done differently? At what point
> would you apply damage control principles? The
> vascular injuries did not appear amenable to
> packing....Any thoughts?
>
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GSW to abdomen