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Mon Jun 27 14:39:59 BST 2005

PS These were all low-velocity GSW!

P Navsaria

UCT Staff Member - navsaria wrote:
> 
> Dear Geehan
> 
> We have treated 5 cases of combined isolated extraperitoneal bladder and
> rectal injury as follows:
> 
> Patient needs theatre - give antibiotics (AB) stat.
> 
> 1.  Cystogram - if intraperitoneal leak proceed to laparotomy, if
> extraperitoneal proceed as follows.
> 
> 2.  EUA: speculum vagina: repair laceration (we call gynae) if present
> 
>     EUA: proctosigmoidocopy - is lesion intra/extraperitoneal? (can be
> difficult to tell sometimes - but gives     an idea of the level of
> injury)
> 
> 3.  Diagnostic laparoscopy (DL)- if positve for blood/peritoneal
> violation - laparotomy
> 
>     DL - negative - do trephine sigmoid loop colostomy - no DRW or PSD
> 
> 4.  Contine AB - MUST BE APYREXIAL FOR 24 HOURS
> 
> 5.  Leave urinary catheter IN for 7 days - repeat cystogram on day 7 -
> if normal - remove catheter.
> 
> 6.  SACC - we have no experience
> 
> NO fistula, no sepsis in 5 patients we have treated as such.
> 
> Sincerely
> 
> P Navsaria
> CAPE TOWN, SA
> 
> 
> 
> "Geehan, Douglas" wrote:
> >
> > Now that we've all checked in again, how about a clinical case...?
> >
> > 17 y/o woman with a gunshot wound just right of midline in the suprapubic area.  ABC's normal.  Abdomen nontender.  Patient currently menstruating.  Gross blood on rectal exam and gross hematuria with placement of Foley catheter.
> >
> > Now what??
> >
> > Regards,
> >
> > Douglas Geehan, M.D.
> > Assoc Professor
> > UMKC Department of Surgery
> > geehand at umkc.edu
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pelvic gunshot wound