GSW to liver

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In a message dated 12/31/2007 11:01:15 P.M. Eastern Standard Time,  
errington at erringtonthompson.com writes:

Sal  -

Here's my problem with that approach.  You know that in the next  12 - 24
hours, the patient will have more abdominal pain and maybe some  distension.
Now, what?  

Errington C. Thompson, MD, FACS,  FCCM
Trauma/Surgical Critical Care
Author - Letter to  America
Asheville, NC



i think it is fair to say that 
 
1. there are hepatic wounds with obvious missile tracts that clearly miss  
the bowel. These are clearly isolated hepatic injuries and can be managed  
expectantly with interventions for bleeding or biliary leakage.
 
2. There are hepatic injuries with suspicion of colon injury with no small  
bowel within the obious trajectory. These can be treated the same way, provided 
 a colon injury can be excluded. A CT enema is very reliable for this 
purpose.  Diagnosis of colon injury obviously purchases a ticket to the OR
 
3. There are hepatic injuries that extend into the peritoneal cavity in an  
indeterminant way where small bowel injury, pancreas, duodenal injury is a  
possibility. Such injuries need to be managed by laparotomy as imaging and  
clinical observation are not sufficiently accurate.
 
works for me



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