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Tue Apr 25 13:00:42 BST 2006

Doug,
After I sent that post I KNEW that I had misrepresented my thought
process.....  I would consider one at any age, if it were necessary to
ensure wound healing.  In this case I was thinking (in my own mind) that
she most likely would be well-nourished, and capable of maintaining a
clean wound without soilage when moving her bowels.

Thanks for making me clarify  ;-)

Ron

>>> "Geehan, Douglas" <geehand at umkc.edu> 04/24 9:15 PM >>>
Ron,

At what age would you consider a diverting colostomy???

Regards,

Doug

Douglas Geehan, M.D.
Associate Professor
Department of Surgery
University of Missouri-Kansas City
geehand at umkc.edu 

________________________________

From: trauma-list-bounces at trauma.org on behalf of Ronald Gross
Sent: Mon 4/24/2006 8:24 AM
To: trauma-list at trauma.org 
Subject: Re: bloody rectum...

EUA to be able to 1. examine extend of "perianal" (vs prineal) wound
and
2. do a very thorough and slow rigid sig with ability to insufflate,
wipe and observe.  BaE of no real use here as I see it, and I woudl
suspect that CT with rectal contrast will be of little help as well.
Assuming no other injuries, drain/pack wound, with diligent wound
care.
 Given patient's age, one would hope to avoid diverting
colostomy.......
Do you have any photos of the actual wound?  That would help here.

Take care,
Ron

>>> joe.nemeth at staff.mcgill.ca 04/24 7:56 AM >>>
once again:

-30 y.o.female
-straddle injury, picket fence
-sustains "deep" perianal lac.
-DRE: good tone, no blood
-rig. sig.:fresh blood distal rectum ("?maybe ED doc's bloody fingered

DRE exam")
-fleet enema
-repeat sig: same
-CT with rectal contrast: neg.

what next?...

--
Dr. Joe Nemeth
Assistant Professor
Emergency Medicine
Montreal General Hospital
Montreal Children's Hospital
McGill University Health Center

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bloody rectum...