List Archives

Thu May 10 13:10:47 BST 2007

How about patients with omental evisceration? What would be your  
protocol then?

E Daza MD FACS

On May 10, 2007, at 8:19 AM, <YoramKl at clalit.org.il> wrote:

> Errington
> If you open every patient with peritoneal violation (it's actually  
> fascia violation), the rate of non-therapeutic laparotomy will be  
> more than 30%. It was proved that observation in this group is  
> safe. I totally agree about the need for qualified nurses and  
> residents. If the hospital's staff can't support adequate patient  
> follow-up, than I think it's better to send the patient to another  
> facility (if possible) than to operate an unnecessary operation.
> Regards
> Yoram
>
> -----Original Message-----
> From: Errington Thompson [mailto:errington at erringtonthompson.com]
> Sent: Thursday, May 10, 2007 6:44 AM
> To: 'Trauma &amp; Critical Care mailing list'
> Subject: RE: stab wounds to anterior abdomen
>
> What is your comfort level?  I like wound explorations in patients  
> that will
> be still.  It doesn’t take long.  I can washout the wound and close  
> it in 15
> - 20 minutes.  The key seeing the whole wound.  You need good  
> lighting.  If
> you don't have that then go to the OR and do the same thing.  IN  
> the OR use
> your retractors see everything.  Don't guess. If the peritoneum is  
> violated
> open the patient.  If it isn't then close the wound and send the  
> patient
> home.
>
> Serial abdominal exams are labor intensive.  Would not use unless  
> you have
> residents and an excellent nursing staff.  Need to monitor these  
> patients.
>
> I use CT a lot in abdominal trauma but not really for evaluation of  
> the
> anterior abdomen with a penetrating wound.
>
> My 2 cents.
>
> Errington C. Thompson, MD, FACS, FCCM
> Trauma/Surgical Critical Care
> Mission Hospital
> Asheville, NC
> Author - A Letter to America
> www.whereistheoutrage.net
>
>
> Everyone deserves to make an informed decision
>                                 - Errington Thompson, MD
>
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list- 
> bounces at trauma.org]
> On Behalf Of Abdullah Harthy
> Sent: Wednesday, May 09, 2007 9:40 PM
> To: Trauma &amp; Critical Care mailing list
> Subject: stab wounds to anterior abdomen
>
> I was recently presenting a case scenario to a group
> of surgical residents, and we had a bit of a debate on
> how to manage pt.. with stab wound to the anterior
> abdomen (not in the cardiac box), hemodynamically
> stable, no peritonitis. Wound exploration, CT abdomen
> vs. serial abdominal exam.
> I'd like to know the group  practice is (considering a
> lot of our patients are intoxicated with one thing or
> another). I would also appreciate referrences if
> available. How low is your threshold for an
> explorative laprotomy.
>
> Abdullah Al- Harthy
>
>
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stab wounds to anterior abdomen