R: GSW to liver

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Is there any data to support a stent would not be helpful as it is for
cystic stump leaks?  I am assuming that you are saying that a stent IS
indicated.  To that I would say YUP!
And wouldn't ercp be the procedure of choice to define a ductal injury?
 YUP
PS-how many feel octreotide would be helpful  decreasing hepatic
secretions??  NOPE

Just my 2 cents.

Ron

>>> <nappio at aol.com> 1/1/2008 5:30 PM >>>
Any injury with a persistant leak must have some reasonable tributary
of an intrahepatic duct injured. Is there any data to support a stent
would not be helpful as it is for cystic stump leaks?  And wouldn't ercp
be the procedure of choice to define a ductal injury?  
PS-how many feel octreotide would be helpful  decreasing hepatic
secretions??  DN
Sent from my Verizon Wireless BlackBerry

-----Original Message-----
From: "Peter" <taliente at tiscalinet.it>

Date: Tue, 1 Jan 2008 23:02:12 
To:"'Trauma &amp; Critical Care mailing list'"
<trauma-list at trauma.org>
Subject: R: GSW to liver


I think that the placement of a stent  does nothing to improve drainage
in
this case, but is an invasive procedure with a possibility of
increasing the
risk of infection. The biliary output will decrease spontaneously.
Peter

-----Messaggio originale-----
Da: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] 
Per conto di Tchaka Shepherd
Inviato: lunedì 31 dicembre 2007 6.27
A: Trauma & Critical Care mailing list
Oggetto: RE: GSW to liver



If the patient remains stable. ERCP with stent placement should provide
a
path of least resistance and significantly decrease your drain output.
Isolated liver injuries with hemodynamic stability infrequently need
operative intervention.



----------------------------------------
> From: jamac at pacific.net.ph 
> To: trauma-list at trauma.org 
> Date: Thu, 11 Dec 2003 18:17:25 +0800
> Subject: Re: GSW to liver
> 
> Dr. Thompson,
> I will also take the patient to the OR. Seeing the extent of his
injury, I
> will place a balloon tamponade and drain.
> Thanks.
> Joel U. Macalino, MD
> Philippines
> ----- Original Message -----
> From: Errington Thompson 
> To: 'Trauma & Critical Care mailing list' 
> Sent: Sunday, December 30, 2007 1:06 PM
> Subject: GSW to liver
> 
> 
> I have a couple of questions on a recent case.  30 yo male was too
drunk
to
> have a gun but had one nonetheless.  He shot himself in the right
upper
> quadrant.  He was stable, awake and talking in the ER.  Entrance
wound
> easily seen just under the ribs and just lateral to the
mid-clavicular
line.
> The bullet was palpable just under the skin at about the 12th rib. 
No
SOB.
> 
> 
> 1) CT or not CT scan.  IF you do scan the patient and see a thru and
thru
> wound the liver, can you just watch him?
> 
> I take the patient to the OR.  He indeed has a thru and thru GSW to
the
> liver.  The wounds are not really bleeding.  There is no bile oozing
from
> either wound.
> 
> 2) Drain or no drain?
> 
> The patient develops an ileus and bile peritonitis.  He is
percutaneously
> drained.  On day 5 with his drain output still over 300 cc per day
the
> character of the drainage changes to a dark green.  CT scan revealed
an
> abscess posterior to the liver.  Percutaneous drainage was
performed.
> Enterococcus in the fluid.  Antibiotics were started.  Antiobiotics
stopped
> after 7 days.
> 
> Thoughts?
> 
> 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
> 
> 
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> 
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