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Fri Apr 9 23:24:00 BST 2004

Forwarding this message which appears to have nounced:

Karim

-----Original Message-----
From: Morrow, Charles [mailto:cmorrow at srhs.com]
Sent: 09 April 2004 15:08
To: trauma-list-bounces at trauma.org
Subject: adynamic ileus

I am caring for a 40 y/o patient who is now 2 weeks out from a MVC in which
he suffered a spinal cord injury at the C3 level and is now a quad. There
were no other injuries.

Initially he was in neurogenic shock which was controlled after a small
amount of crystalloid followed by low dose dopamine. He was normotensive and
off dopamine in less than 12 hours.

He has had an ileus since admission. He underwent early trach/PEG (day 4).
With worsening distension, ileus now causing some respiratory compromise,
multiple consultants were obtained at the families request. All urged ex lap
for missed injury, malpositioned PEG, despite 2 neg CT scans. At exploration
had NO missed injuries and appropriate placement of the PEG tube. Small
bowel was grossly distended, > 10 cm at the distal ileum. All of small bowel
was thick with inflammatory reaction but pink. No parastalsis was seen. The
bowel was decompressed unsuccessfully with the PEG and an NGT so complete
decompression was done with an incidental appendectomy.

Post op respiratory status greatly improved. Never a fever or white count
elevation. Ileus continued and is now back at original massive size with
respiratory compromise. We have tried multiple bowel regimens, reglan, ERYC,
etc with no effect.

Anyone have any suggestions?
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