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Tue Aug 29 18:45:04 BST 2006

Just one comment:

  Primum non nocere
  This case is one dramatic example of "doing nothing" as the best way to damage a patient.
  You don't have nothing to loose by following Dr Mattox suggestion. When you stop having control on the evolution of this kind of patient, the colapse is imminent unless you get back to control his outcome.

  Manuel Saenz MD
  Hospital General de Chihuahua
  Chihuahua, México

  Juan Duchesne <JDuchesne at surgery.umsmed.edu> escribió:
  K-
Very attractive idea I have to say.........will start with anatomical
road map and CT abdomen for starter............forgot to
mention.......Mom is CRNA and DAD is MD (will be hard to convince them
to consent for that blind stick approach)........will keep you posted.

Juan C Duchesne, M.D.
University of Mississippi Medical Center
Assistant Professor of Surgery/Trauma and Critical Care
2500 North State Street
Jackson MS 39216

>>> KMATTOX at aol.com 08/24/06 9:29 PM >>>

In a message dated 8/24/2006 9:16:21 P.M. Central Standard Time, 
JDuchesne at surgery.umsmed.edu writes:

..........I am stuck with TPN
for now (DISGUSTING IDEA!!).....and my IR guys doesn't want to
attempt
percutaneous small bowel feeding access..

Maybe I am the only person on this list server that has the courage and
guts 
to suggest this to you. But I think I would maybe try something that
has 
NEVER been done to my knowledge. 

You say the abdomen is FROZEN, I believe you. USE the forzen belly
to your 
therapeutic advantage. 

Go to ICU or OR (not IR)
Prep the LUQ
Take a long 22 gauge spinal needle
Aspirate below where the left transverse colon should be
Have a wire ready
When you get BILE push in the wire,
Thread in a tiny catheter and aspirate again. 
IF GOOD Bile is still present push the catheter further
Inject some dye and take an x-ray, If dye is in colon, pull it out
and do 
it again.,
If in small bowel (ANYWHERE) push it in further and secure it to the 
skin
FEED him through the catheter for minimum of 1 month, while sucking 
on NG 
tube
If he tolerates it after the first week. Put in a new wire
Dilate the channel
Put in a LARGER catheter
Repeat in a week. 

Let me know what you think and what you do.

If anyone on this list has done this BLIND sticking of small bowel in a

frozen abdomen, take credit for it and write it up tonight. If you
dont, Im 
going to do it or have one of my faculty or residents write it up. 

k.

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