Ilio-sigmoid anastomosis prior to abdominal closure in multitraumapatient

• Previous message: Ilio-sigmoid anastomosis prior to abdominal closure in multitraumapatient
• Next message: Ilio-sigmoid anastomosis prior to abdominal closure in multitrauma patient
• Messages sorted by: [ date ] [ thread ] [ subject ] [ author ]

Dear Tim,
 
I would not consider in this patient anastomosis on day 4.
 
What was the source of oozing on day1?
 
Did the craniotomy made him coagulopathic or had continued ooze from
the pelvic fx?
 
What were the IAPs during Day0 and Day1? Could that contribute to the
colon necrosis?
 
Good luck with this difficult case.
 
Best regards,
 
Zsolt Balogh

>>> tim cooper <tcooper86 at hotmail.com> 20/08/2008 7:48 am >>>

Ilio-sigmoid anastomosis prior to abdominal closure in multitrauma
patient
A recent case at our trauma centre has raised the question of the
timing and relative risks/benefits of bowel anastomosis in the
multitrauma patient.

67 year old female, pedestrian hit by car, GCS 3 on scene, major head
and abdominal trauma, unstable T1 fracture, multiple pelvic fractures
with blush (embolized) 
Day 0: Damage control laparotomy with splenectomy, mesenteric bleed
found, ~10cm small bowel resection, abdomen left open 
Day 1: Re-laparotomy with subtotal colectomy (colon found to be
necrotic, sigmoid spared), iliostomy, TAC. Concurrent craniotomy for
expanding extradural, and ICP monitor placement * post op continuous
oozing through vac, additional re-laparotomy that afternoon for packing,
VAC reapplied 
Day 4: tracheostomy and 2nd relook laparotomy for washout and primary
closure 
~60 units of packed cells, 20 of FFP and 20 of cryoprecipitate
transfused during these first 72 hours 
Currently GCS 4 (on day 7) 
Plan to anastomose ileum and sigmoid at later date 
Suggestion was made that anastomosis of ileum and sigmoid could have
occurred during the last laparotomy prior to definitive closure,
avoiding the risks of an additional laparotomy etc. Has anyone had
experience with this approach? What are people*s thoughts? Thanks! Tim
(Sydney, Australia)

_________________________________________________________________
It's simple! Sell your car for just $40 at CarPoint.com.au
http://a.ninemsn.com.au/b.aspx?URL=http%3A%2F%2Fsecure%2Dau%2Eimrworldwide%2Ecom%2Fcgi%2Dbin%2Fa%2Fci%5F450304%2Fet%5F2%2Fcg%5F801459%2Fpi%5F1004813%2Fai%5F859641&_t=762955845&_r=tig_OCT07&_m=EXT

--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/

• Previous message: Ilio-sigmoid anastomosis prior to abdominal closure in multitraumapatient
• Next message: Ilio-sigmoid anastomosis prior to abdominal closure in multitrauma patient
• Messages sorted by: [ date ] [ thread ] [ subject ] [ author ]