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Difficult complication

trauma-list@trauma.org trauma-list@trauma.org
Sun, 27 Apr 2003 22:38:11 EDT


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If bowel is DEAD, then the bowel must come out.  If the bowel is still 
ischemic and reversible at second look, I bring a Goretex graft off the 
common iliac, keep it retroperitoneal and suture it to the SMA at an open 
site.   I might look for an embolus and try once to remove or desolve it.   I 
personally think the problem is at the take off of the SMA from the aorta and 
a more distal bypass would keep it open.   Sal Sclafani might indicate that a 
stent might work in this situation.   This is a very rare event and not much 
experience and NO prospective series.   One has to rely on judgment and 
experience as to what has worked in the past in this case.     

k

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<HTML><FONT FACE=3Darial,helvetica><FONT  SIZE=3D2 FAMILY=3D"SANSSERIF" FACE=
=3D"Arial" LANG=3D"0">If bowel is DEAD, then the bowel must come out.&nbsp;=20=
If the bowel is still ischemic and reversible at second look, I bring a Gore=
tex graft off the common iliac, keep it retroperitoneal and suture it to the=
 SMA at an open site.&nbsp;&nbsp; I might look for an embolus and try once t=
o remove or desolve it.&nbsp;&nbsp; I personally think the problem is at the=
 take off of the SMA from the aorta and a more distal bypass would keep it o=
pen.&nbsp;&nbsp; Sal Sclafani might indicate that a stent might work in this=
 situation.&nbsp;&nbsp; This is a very rare event and not much experience an=
d NO prospective series.&nbsp;&nbsp; One has to rely on judgment and experie=
nce as to what has worked in the past in this case.&nbsp;&nbsp;&nbsp;&nbsp;=20=
<BR>
<BR>
k</FONT></HTML>

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