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Wed Jan 24 18:29:49 GMT 2007

Maybe that's because the first response posted (stent and thoracotomy) was judged satisfactory by many on the list... Or maybe it's because community surgeons like me aren't too sure of what exactly is the place of stenting in trauma, and that we don't have angio anyway in our hospital...

So just for the sake of discussion, let me add a couple of potential nodes to this problem: you've got the same patient, stable, in a canadian north community hospital, with competent surgeons although not routinely doing big chest surgery, a few hours ambulance ride (no choppers here!) to level one trauma center, would you transfer with the inherent delay and risk of the innominate blowing up, or do-it-yourself?  I'm a lot more afraid of the morbidity of the innominate repair (and its approach) than the esophagus, especially if stenting would work here...

And don't tell me I would'nt know anyway about the innominate, since angio CT didn't show it and I don't have real angio... I said it was for the sake of discussion!

JP Arsenault

Still waiting for the rest of this interesting case...

----- Original Message ----

Thanks Phil.    I got many responses from ccml, but almost  none from 
trauma-list.  That was the reason for the inquiry

k
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