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Thu May 24 11:14:55 BST 2007

Pradeep

Nice article! I can attest that our experience is identical in over 80 patients with extraperitoneal rectal injury over the last three years and we only do a loop stoma and repair of UT-structures. No rectal related mortality and minor wound sepsis as morbidity. We don't do routine "loopograms" prior to closure as we have found these unnecessary in studies we have done in-house. We have to date not had any leaks or sphincter problems.

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
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Pradeep Navsaria
Sent: Thursday, May 24, 2007 10:24 AM
To: trauma-list at trauma.org
Subject: Re: PELVIC GSW

A reference that maybe useful in answering your question:

Civilian extraperitoneal rectal gunshot wounds: surgical management made simpler.
World J Surg. 2007 Jun;31(6):1347-53. 
PMID: 17457641 [PubMed - in process]

Sincerely

Pradeep N

>>> "Fernando Aguilar" <draguilarrevelo at gmail.com> 05/24/07 1:10 AM >>>
I would like to hear your approach to the following case:
Male, 32, gunshot wound to left lateral inferior flank (see picture 01), no
exit wound, arrive ER 20 min. after injury.  BP: 120/75, P: 90, SatO2: 98%,
no cristalloids given.
Abdomen tender in lower quadrants. FAST Neg.  Rectal: normotonic, feces with
little blood.  Pulses: OK.
Abdominopelvic x-ray taken (see picture 02)
CAT Scan shown (pictures 03, 04, 05)

My hospital is a General Hospital and is one of the 3 mayor hospital at my
country.  We manage all trauma patients.

Dr. Fernando Aguilar
General Surgeon
Calderon Guardia General Hospital
San José, Costa Rica

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