A difficult abdominal case.

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Close the abdomen and put on a morphine infusion - survival not
possible! Unless you have lifelong home TPN, which is unlikely given
where you are?

Tim
Dr Timothy C Hardcastle
M.B., Ch.B. (Stell); M. Med (Chir) (Stell); FCS (SA)
Principal Surgeon-Lecturer / Sub-specialist: Trauma and Critical Care
Deputy director: Trauma Unit and Trauma ICU
Inkosi Albert Luthuli Central Hospital / UKZN
800 Bellair Road
Mayville, Durban
 
Postal: PostNet Suite 27
Private Bag X05
Malvern, 4055
KwaZulu Natal
 
timothyhar at ialch.co.za 
 

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of rm khattar
Sent: 10 July 2008 13:28
To: trauma-list at trauma.org
Subject: A difficult abdominal case.

The CT which he has brought from the Govt. facility shows normal
Pancreas.We do his amylase and lipase which are normal. Erect abdomen
radiograph does not reveal any free gas under right diaphragm but has
air fluid levels in upper abdomen.After coming to us he starts
deteriorating rapidly.Bedside USG does not reveal gall stones,only
moderate fluid in abdomen.
He undergoes Laparotomy,within few hours of arriving at our facility.
2-3 litres of brownish fluid is removed and except 3 feet of jejunum,the
entire small bowel is gangrenous,the gangrenous involvement is frank
except for terminal bowel which has patches of full thickness
gangrene,the caecum ,ascending colon and hepatic flexure has similar
findings.There is sharp demarcation detween vascularized and
nonvascularized bowel at jejunal and colonic ends.Even the mesentry
appears black in the involved areas.Beyond hepatic flexure colon apperas
well perfused.
What would you have done in such a situation?
Apolgise for delay ,in answering.
R.M.Khattar,Delhi


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