SV: Lapaoscopy in penetrating trauma

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Next step:
We continued observation in the ICU. The next day the hemoglobin was 9.3 g/dl. 
CT with peroral contrast the next day did not reveal any hollow viscus injury or increase of the subcapsular hematoma. (Maybe pure luck?)
At day 4, the chest tube was removed and he is doing well. But, I know there must be a diaphragm injury.
What now? 

Kari



-----Opprinnelig melding-----
Fra: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] På vegne av docrickfry at aol.com
Sendt: 6. mars 2006 22:18
Til: trauma-list at trauma.org
Emne: Re: Lapaoscopy in penetrating trauma

I would open and remove or fix the spleen--after that much blood loss and subcapsular hematoma chance of rebleed is high without treatment of some sort--and of course fix the diahragm laceration that you know must be present.  I am not sure what value there is to "localizing" diaphragm injury you already know is there. Also there is great potential here for hollow viscus injury with this trajectory which can NOT be excluded by absence of air on CT, requiring open exploration of wound track.
ERF
 
-----Original Message-----
From: "Hansen, Kari Schrøder" <kari.schroder.hansen at helse-bergen.no>
To: trauma-list at trauma.org
Sent: Mon, 6 Mar 2006 21:51:45 +0100
Subject: Lapaoscopy in penetrating trauma



Man, 37 years. Falls and hit a metal tool. 
He gets a penetrating wound i the left lower chest (7th intercostal space)

Awake, stable. BP 175/90. RR 40, shallow. HR:100

He has a left tension pneumothorax + hemothorax. Chest tube inserted which 
drains about 1 litre of blood immediately. No further ongoing bleeding on the 
chest tube.
CT shows an injury through the spleen with a small amont of free fluid in the 
abdomen and a subcapsular hematoma. No air in the abdominal cavity.

Would you do a laparoscopy (to localize any injury to the diaphragm), continue 
observation or do an open exploration?



Kari Schrøder Hansen
Consultant General Surgery
Deptartment of Surgery
Haukeland University Hospital
Bergen, Norway
Tlf: +47 55 97 2811  Fax: +47 55 97 27 93
e-mail:<mailto:kari.schroder.hansen at helse-bergen.no> 
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