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Thu May 10 13:39:50 BST 2007

No

Omental evisceration only allows for ligation and replacement of the stump into the abdomen. If they have no other signs warranting laparotomy they get the same observation protocol as the others - all we know for sure is that the peritoneum was violated. This alone does NOT warrant routine laparotomy in the year 2007!

Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS  instructor and DSTC Cape Town Course Director
Intern program Coordinator: Surgery
M.Med (Emergency Medicine) Executive Committee member
Clinical Head (Director): Diana Princess of Wales Trauma Unit
Division of Surgery (General) Room 4064
Department of Surgical Sciences
Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
South Africa
e-mail: tch at sun.ac.za
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-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of saad shebrain
Sent: Thursday, May 10, 2007 2:15 PM
To: Trauma &amp, Critical Care mailing list
Subject: Re: stab wounds to anterior abdomen

OR--> X-lap

Enrique Daza <edazamd at verizon.net> wrote:  How about patients with omental evisceration? What would be your 
protocol then?

E Daza MD FACS

On May 10, 2007, at 8:19 AM, 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 & 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 & 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