List Archives

Fri Aug 25 02:13:52 BST 2006

You have a bad situation and you dont have much time left to get out of  real 
deep trouble.   Your exclusion is not going to open up as you  want it to do. 
  You are going to get a quatranary duodenal blowout,  from which you and the 
patient will not  survive.       If you wait much longer, you will  be unable 
to do a gastrojejunostomy because of the foreshortening of the  mesentery.    
 It already may be too late.   

You have to get some hook up between the stomach and the jejunium or you  are 
going to have a frozen abdomen and be on IV alimentation for a long time,  
with a good gut there unused.    

I would recommend going in abdomen, assuring that you have a closed pylorus  
at the pylorus and then do either a Roux en Y or a loop  gastrojejunostomy.   
BE SURE TO BE ON THE DEPENDENT PROTION OF THE  GREATER CURVE.   

DO NOT DO A VAGOTOMY.   

Drain the RUQ .  Put in TWO tubes into the stomach,   One  for drainage and 
one threaded through the gastrojejunostomy and far down into  the jejunium

Buy Top Knife.  

k

List Archives

For your convenience, find the Trauma List Archive Below

Pyloric exclusion