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Sun Dec 21 18:26:30 GMT 2008

While I don't think any will argue that a laparotomy on a morbidly obese person can be fraught with technical problems as well as higher than normal rates of postoperative complications, the hollow viscus thickening described on CT in combination makes one worry more about devitalized intestine less than hemorrhage making me believe that you can't help but operate.  If this were a smaller sized person, I'd probably say operate, with impunity. 

But if the questions is 'how can we safely avoid an operation' I guess I would ask, given that he is 5-6 hours post trauma:

1.  Do the areas of splenic flexure / small bowel thickening enhance on CT?
2.  Any melena?  Guiac positive?
3.  Hemoglobin / base deficit after resuscitation?  Serially?
4.  Most importantly what is his abdominal exam?

Ben Reynolds, PA-C
Pittsburgh, PA

________________________________
From: khumar huseynova <khumarhuse at yahoo.ca>
To: Trauma Trauma <trauma-list at trauma.org>
Sent: Saturday, December 20, 2008 9:29:30 PM
Subject: Stable pt w mesenteric extrav

Another case we saw 2 days ago:

67M post-MVA single rollover, brought to us about 5-6hrs post-accident. BMI>30. Stable vitals, GCS=14-15. CT abdo showed segmental SB and splenic flexure thickening with active but completely contained in the LUQ extrav from the mesenetery. Very small amount of FF in the pelvis, no other injuries, no FA.
Anyone have experience with embolization of mesenteric branches after checking for collaterals during angio? Or would u take him to OR solely based on CT findings even if the hematoma/extrav was very small and contained?

K

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Stable pt w mesenteric extrav