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Wed Mar 8 21:11:23 GMT 2006

The answer is of course no--not enough data has been compiled by anyone for such a guidleine to be made.  However, the real question should be--what are the guidelines for intervention on asymptomatic individuals with penetrating low thoracic wounds on the left with no other indication for surgery.  And again, you will see little data on the natural history of those wounds.  And of course, it is those advocating intervention who have the burden of justifying such, and that approach cannot be justified by anything more than anecdotal testimonials--there certainly is no dearth of the latter, to be sure, but unfortunately they count for nothing except exciting war stories.
ERF

-----Original Message-----
From: Dean Lutrin <deanlutrin at gmail.com>
To: 'Trauma &amp; Critical Care mailing list' <trauma-list at trauma.org>
Sent: Wed, 8 Mar 2006 22:50:49 +0200
Subject: RE: SV: Lapaoscopy in penetrating trauma

Doug,

How should one follow up a patient with a left sided thoracoabdominal stab
with a benign abdomen and a hemopneumothorax. CXR after a week, a month?
Only come back when symptomatic? Are there any guidelines for surveillance
for a diaphragmatic hernia.

Dean Lutrin

JHB, SA

  _____  

From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Geehan, Douglas
Sent: 08 March 2006 10:03 PM
To: Trauma & Critical Care mailing list
Subject: RE: SV: Lapaoscopy in penetrating trauma

Ron,

Actually, the cases and the posture that we discussed several times in the
past had to do with penetrating trauma to the lower chest or the
thoracoabdominal area.  There was a group of physicians who were advocating
some kind of test to exclude diaphragmatic injury.  Eric pointed out that,
on either side, the patients can be watched without intervention or
investigations if there is no overt evidence of abdominal injury requiring
repair.

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: Tue 3/7/2006 11:30 AM
To: trauma-list at trauma.org
Subject: RE: SV: Lapaoscopy in penetrating trauma

Doug,
Do you recall which side Eric was referring to when he spoke to
non-operative management of a diaphragmatic injury from a stab wound?  I
think I do - and it was on the right side.  There is this thing called the
liver that would allow one to manage a stab would conservatively on the
right.  Blunt injury is a whole other issue, and believe your ears when even
Eric (I think) would advocate repair.
Best wishes,
Ron

>>> geehand at umkc.edu 03/07 10:36 AM >>>
Eric,

Can I believe my ears?  Are you really advocating fixing an asymptomatic
diaphragmatic hernia?  What happened to all that passion about leaving these
injuries alone?  I recall enthusiastic discussions from you regarding how
unlikely these injuries were to cause trouble when discussed in the setting
of stab wounds.  What makes this case different?

Regards,

Doug

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SV: Lapaoscopy in penetrating trauma