List Archives

Fri Oct 23 22:18:21 BST 2009

As I quoted before, "Folly that is successful (or in these reports didn't kill anyone) is folly none the less".
Ron

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of caesar ursic
Sent: Friday, October 23, 2009 4:39 PM
To: Trauma-List [TRAUMA.ORG]
Subject: Re: Ref:selectice conservative management of stab injury abdomen-roleof ct in pt wthout peritonitis , hemodynamically stable pt

*Yet, Dr. McSwain,  it is interesting how many trauma centers routinely and
methodically perform laparotomies on anterior abdominal stab patients with
no signs of peritonitis/evisceration/shock simply because they have
peritoneal penetration (noted either on local wound exploration or
laparoscopy).*
**
*Why is this?*
**
*C. Ursic, MD*
*general surgeon*
**

Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of McSwain, Norman E Jr.
Sent: Friday, October 23, 2009 10:35 AM
To: Trauma-List [TRAUMA.ORG]
Subject: RE: Ref:selectice conservative management of stab injury
abdomen-roleof ct in pt wthout peritonitis , hemodynamically stable pt

But as Carter Nance taught us in the 1960's (previous quoted article), a
hole in the peritoneum is NOT a reason to do a laparotomy. It is simply an
indication to do serial observational physical examinations on the patient.
The indication for surgery is an acute abdomen on examination or hemodynamic
instability. If a  hole in the peritoneum from a stab wound was an
indication for surgical exploration, every patient who has peritoneal
dialysis would undergo a laparotomy.
Norman
Norman McSwain MD
Professor, Tulane School of Medicine
Trauma Director, Charity Hospital Trauma Center
norman.mcswain at tulane.edu
504 988 5111
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Ref:selectice conservative management of stab injury abdomen-roleof ct in pt wthout peritonitis , hemodynamically stable pt