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Sun, 30 Mar 2003 15:01:41 -0600

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To the OR!!

E

Errington C. Thompson, MD
Trauma/ Surgical Critical Surgeon
Tyler, Tx
ecthompson@msn.com

I can only show you the door
                                         - Morpheus (The Matrix)

-----Original Message-----
From: trauma-list-admin@trauma.org [mailto:trauma-list-admin@trauma.org]
On Behalf Of Karim Brohi
Sent: Sunday, March 30, 2003 6:09 AM
To: trauma-list@trauma.org
Subject: RE: Renal injury - Part 3

So this is exactly what we did.  Cleaned out & got out.  All well.
Patient had low grade fever persisting through Day 4, moderate white
cell count.  CT showed good contrast uptake in left kidney apart from
lower pole.  Patient remained stable.  No intervention.

Day 8-10 pus started appearing through initial stab wound and drained
200 mls/day for 8 days.  Patient remained well with normal white cell
count and temperature around 37.4, but complained of being very
uncomfortable in left abdomen with ful ness and discomfort in left
abdomen.  Pus continued to drain from wound site with no sign of slowing
down.

Repeat CT shows significant perinephric collection (not well seen on
this cut), swelling around left psoas and free air related to the
kidney:

Now what?

Karim
-----Original Message-----
From: trauma-list-admin@trauma.org
[mailto:trauma-list-admin@trauma.org]On Behalf Of DocRickFry@aol.com
Sent: 29 March 2003 14:05
To: trauma-list@trauma.org
Subject: Re: Renal injury - Part 2
In a message dated 3/29/2003 7:38:24 AM Eastern Standard Time,
karim@trauma.org writes:

Although no other injuries were apparent went on to full laparotomy -
including inspection and exploration of a haematoma around the
descending colon.  This revealed a 2cm laceration to the descending
colon, which was repaired primarily.  But not before it leaked faecal
contents all over the kidney and kidney repair.

Now what?

You are through!  Clean up the gross contamination as best you can and
leave a drain as should have been part of the plan anyway--the
contamination really should not alter your approach beyond cleaning it
out.  Certainly your antibiotic coverage should remain perioperative
only and not be changed by this--the existing evidence cannot be clearer
on this point.
ERF 

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<p class=3DMsoNormal><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
style=3D'font-size:12.0pt;mso-bidi-font-family:Arial;color:navy'>To the =
OR!!<o:p></o:p></span></font></p>

<p class=3DMsoNormal><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
style=3D'font-size:12.0pt;mso-bidi-font-family:Arial;color:navy'><o:p>&nb=
sp;</o:p></span></font></p>

<p class=3DMsoNormal><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
style=3D'font-size:12.0pt;mso-bidi-font-family:Arial;color:navy'>E<o:p></=
o:p></span></font></p>

<p class=3DMsoNormal><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
style=3D'font-size:12.0pt;mso-bidi-font-family:Arial;color:navy'><o:p>&nb=
sp;</o:p></span></font></p>

<div>

<p class=3DMsoAutoSig><st1:PersonName><font size=3D3 color=3Dnavy
 face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;color:navy;mso-no-proof:
 yes'>Errington</span></font></st1:PersonName><font color=3Dnavy><span
style=3D'color:navy;mso-no-proof:yes'> C. Thompson, =
MD<o:p></o:p></span></font></p>

<p class=3DMsoAutoSig><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
style=3D'font-size:12.0pt;color:navy;mso-no-proof:yes'>Trauma/ Surgical =
Critical
Surgeon<o:p></o:p></span></font></p>

<p class=3DMsoAutoSig><st1:place><st1:City><font size=3D3 color=3Dnavy
  face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;color:navy;mso-no-proof:
  yes'>Tyler</span></font></st1:City><font color=3Dnavy><span =
style=3D'color:navy;
 mso-no-proof:yes'>, </span></font><st1:State><font color=3Dnavy><span
  =
style=3D'color:navy;mso-no-proof:yes'>Tx</span></font></st1:State></st1:p=
lace><font
color=3Dnavy><span =
style=3D'color:navy;mso-no-proof:yes'><o:p></o:p></span></font></p>

<p class=3DMsoAutoSig><st1:PersonName><st1:PersonName><font size=3D3 =
color=3Dnavy
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  yes'>ecthompson</span></font></st1:PersonName><font color=3Dnavy><span
 =
style=3D'color:navy;mso-no-proof:yes'>@msn.com</span></font></st1:PersonN=
ame><font
color=3Dnavy><span =
style=3D'color:navy;mso-no-proof:yes'><o:p></o:p></span></font></p>

<p class=3DMsoAutoSig><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
style=3D'font-size:12.0pt;color:navy;mso-no-proof:yes'><o:p>&nbsp;</o:p><=
/span></font></p>

<p class=3DMsoAutoSig><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
style=3D'font-size:12.0pt;color:navy;mso-no-proof:yes'>I can only show =
you the
door<o:p></o:p></span></font></p>

<p class=3DMsoAutoSig><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
style=3D'font-size:12.0pt;color:navy;mso-no-proof:yes'><span
style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp=
;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span>- Morpheus (The Matrix)<o:p></o:p></span></font></p>

</div>

<p class=3DMsoNormal><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
style=3D'font-size:12.0pt;mso-bidi-font-family:Arial;color:navy'><o:p>&nb=
sp;</o:p></span></font></p>

<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D2 =
face=3DTahoma><span
style=3D'font-size:10.0pt;font-family:Tahoma'>-----Original =
Message-----<br>
<b><span style=3D'font-weight:bold'>From:</span></b> =
trauma-list-admin@trauma.org
[mailto:trauma-list-admin@trauma.org] <b><span =
style=3D'font-weight:bold'>On
Behalf Of </span></b>Karim Brohi<br>
<b><span style=3D'font-weight:bold'>Sent:</span></b> =
</span></font><st1:date
Month=3D"3" Day=3D"30" Year=3D"2003"><font size=3D2 face=3DTahoma><span =
style=3D'font-size:
 10.0pt;font-family:Tahoma'>Sunday, March 30, =
2003</span></font></st1:date><font
size=3D2 face=3DTahoma><span =
style=3D'font-size:10.0pt;font-family:Tahoma'> </span></font><st1:time
Hour=3D"6" Minute=3D"9"><font size=3D2 face=3DTahoma><span =
style=3D'font-size:10.0pt;
 font-family:Tahoma'>6:09 AM</span></font></st1:time><font size=3D2 =
face=3DTahoma><span
style=3D'font-size:10.0pt;font-family:Tahoma'><br>
<b><span style=3D'font-weight:bold'>To:</span></b> =
trauma-list@trauma.org<br>
<b><span style=3D'font-weight:bold'>Subject:</span></b> RE: Renal injury =
- Part 3</span></font></p>

<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D3 =
face=3D"Times New Roman"><span
style=3D'font-size:12.0pt'><o:p>&nbsp;</o:p></span></font></p>

<div>

<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D2 =
color=3Dblue
face=3D"Times New Roman"><span style=3D'font-size:10.0pt;color:blue'>So =
this is
exactly what we did.&nbsp; Cleaned out &amp; got out.&nbsp; All =
well.&nbsp;
Patient had low grade fever persisting through Day 4, moderate white =
cell
count.&nbsp; CT showed good contrast uptake in left kidney apart from =
lower
pole.&nbsp; Patient remained stable.&nbsp; No =
intervention.</span></font><o:p></o:p></p>

</div>

<div>

<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D3 =
face=3D"Times New Roman"><span
style=3D'font-size:12.0pt'>&nbsp;<o:p></o:p></span></font></p>

</div>

<div>

<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D2 =
color=3Dblue
face=3D"Times New Roman"><span style=3D'font-size:10.0pt;color:blue'>Day =
8-10 pus
started appearing through initial stab wound and drained 200 mls/day for =
8 days.&nbsp;
Patient remained well with normal white cell count and temperature =
around 37.4,
but complained of being very uncomfortable in&nbsp;left abdomen with ful =
ness
and discomfort in left abdomen.&nbsp; Pus continued to drain from wound =
site
with no sign of slowing down.</span></font><o:p></o:p></p>

</div>

<div>

<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D3 =
face=3D"Times New Roman"><span
style=3D'font-size:12.0pt'>&nbsp;<o:p></o:p></span></font></p>

</div>

<div>

<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D2 =
color=3Dblue
face=3D"Times New Roman"><span =
style=3D'font-size:10.0pt;color:blue'>Repeat CT
shows significant perinephric collection (not well seen on this cut), =
swelling
around left psoas and free air related to the =
kidney:</span></font><o:p></o:p></p>

</div>

<div>

<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D3 =
face=3D"Times New Roman"><span
style=3D'font-size:12.0pt'>&nbsp;<o:p></o:p></span></font></p>

</div>

<div>

<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D2 =
color=3Dblue
face=3D"Times New Roman"><span =
style=3D'font-size:10.0pt;color:blue'><img
width=3D640 height=3D480 id=3D"_x0000_i1025" =
src=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2003-March/3D"cid:image001.jpg@01C2F6CD.4517EE40"></span></font><o:p></o:p></p>

</div>

<div>

<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D3 =
face=3D"Times New Roman"><span
style=3D'font-size:12.0pt'>&nbsp;<o:p></o:p></span></font></p>

</div>

<div>

<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D2 =
color=3Dblue
face=3D"Times New Roman"><span style=3D'font-size:10.0pt;color:blue'>Now =
what?</span></font><o:p></o:p></p>

</div>

<div>

<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D3 =
face=3D"Times New Roman"><span
style=3D'font-size:12.0pt'>&nbsp;<o:p></o:p></span></font></p>

</div>

<div>

<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D2 =
color=3Dblue
face=3D"Times New Roman"><span =
style=3D'font-size:10.0pt;color:blue'>Karim</span></font><o:p></o:p></p>

</div>

<blockquote style=3D'margin-top:5.0pt;margin-bottom:5.0pt'>

<p class=3DMsoNormal =
style=3D'mso-margin-top-alt:0in;margin-right:0in;margin-bottom:
12.0pt;margin-left:.5in'><font size=3D2 face=3DTahoma><span =
style=3D'font-size:10.0pt;
font-family:Tahoma'>-----Original Message-----<br>
<b><span style=3D'font-weight:bold'>From:</span></b> =
trauma-list-admin@trauma.org
[mailto:trauma-list-admin@trauma.org]<b><span =
style=3D'font-weight:bold'>On
Behalf Of </span></b>DocRickFry@aol.com<br>
<b><span style=3D'font-weight:bold'>Sent:</span></b> =
</span></font><st1:date
Month=3D"3" Day=3D"29" Year=3D"2003"><font size=3D2 face=3DTahoma><span =
style=3D'font-size:
 10.0pt;font-family:Tahoma'>29 March 2003</span></font></st1:date><font =
size=3D2
face=3DTahoma><span style=3D'font-size:10.0pt;font-family:Tahoma'> =
</span></font><st1:time
Hour=3D"14" Minute=3D"5"><font size=3D2 face=3DTahoma><span =
style=3D'font-size:10.0pt;
 font-family:Tahoma'>14:05</span></font></st1:time><font size=3D2 =
face=3DTahoma><span
style=3D'font-size:10.0pt;font-family:Tahoma'><br>
<b><span style=3D'font-weight:bold'>To:</span></b> =
trauma-list@trauma.org<br>
<b><span style=3D'font-weight:bold'>Subject:</span></b> Re: Renal injury =
- Part 2</span></font><o:p></o:p></p>

<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D2 =
face=3DArial
FAMILY=3DSANSSERIF><span style=3D'font-size:10.0pt;font-family:Arial'>In =
a message
dated </span></font><st1:date Month=3D"3" Day=3D"29" Year=3D"2003"><font =
size=3D2
 face=3DArial><span =
style=3D'font-size:10.0pt;font-family:Arial'>3/29/2003</span></font></st1=
:date><font
size=3D2 face=3DArial><span =
style=3D'font-size:10.0pt;font-family:Arial'> </span></font><st1:time
Hour=3D"7" Minute=3D"38"><font size=3D2 face=3DArial><span =
style=3D'font-size:10.0pt;
 font-family:Arial'>7:38:24 AM</span></font></st1:time><font size=3D2 =
face=3DArial><span
style=3D'font-size:10.0pt;font-family:Arial'> Eastern Standard Time,
karim@trauma.org writes:<br>
<br style=3D'mso-special-character:line-break'>
<![if !supportLineBreakNewLine]><br =
style=3D'mso-special-character:line-break'>
<![endif]><o:p></o:p></span></font></p>

<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D2 =
color=3Dblue face=3DArial
FAMILY=3DSANSSERIF><span =
style=3D'font-size:10.0pt;font-family:Arial;color:blue;
background:white'>Although no other injuries were apparent went on to =
full
laparotomy - including inspection and exploration of a haematoma around =
the
descending colon.&nbsp; This revealed a 2cm laceration to the descending =
colon,
which was repaired primarily.&nbsp; But not before it leaked faecal =
contents
all over the kidney and kidney repair.</span></font><font color=3Dblack
face=3DArial FAMILY=3DSANSSERIF><span =
style=3D'font-family:Arial;color:black;
background:white'><br>
&nbsp; <br>
</span></font><font size=3D2 color=3Dblue face=3DArial =
FAMILY=3DSANSSERIF><span
style=3D'font-size:10.0pt;font-family:Arial;color:blue;background:white'>=
Now what?</span></font><font
color=3Dblack face=3DArial FAMILY=3DSANSSERIF><span =
style=3D'font-family:Arial;
color:black;background:white'><o:p></o:p></span></font></p>

<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D3 =
color=3Dblack
face=3DArial><span =
style=3D'font-size:12.0pt;font-family:Arial;color:black;
background:white'><br>
</span></font><font size=3D2 color=3Dblack face=3DArial =
FAMILY=3DSANSSERIF><span
style=3D'font-size:10.0pt;font-family:Arial;color:black;background:white'=
><br>
You are through!&nbsp; Clean up the gross contamination as best you can =
and
leave a drain as should have been part of the plan anyway--the =
contamination
really should not alter your approach beyond cleaning it out.&nbsp; =
Certainly
your antibiotic coverage should remain perioperative only and not be =
changed by
this--the existing evidence cannot be clearer on this point.<br>
ERF</span></font><font face=3DArial><span style=3D'font-family:Arial'> =
</span></font><o:p></o:p></p>

</blockquote>

</div>

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