TRANSMEDIASTINAL GSW: second case

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Sal

First do a rigid sig-scope - there is likely to be a missed rectal injury,
which since it is extra-peritoneal can be managed by simple loop stoma. If
no injury and no hematuria, may be lucky patient!

If you want to scan, then rectal and IV contract only!

Tim
Dr T C Hardcastle
M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)
Principal Specialist Trauma Surgeon /
Honorary Lecturer University of KwaZulu-Natal Dept Surgery
Deputy Director - IALCH Trauma Service
Durban - South Africa
>
>  Sometimes i feel like i am on another planet.
> I've been working in a radiology department for 37 years and dying there
> has been uncommon and no worse than any other place to die.
> You must have really crappy radiologists or a really crappy relationship
> with them
>
> This case reminds me of an interesting case we had last weekend in our
> house.
>
> 23 year old male sustained multiple gunshot wounds two months after
> release after nine years in prison. Yes, been incarcerated since age 14.
> There were through and through wounds of the right arm, the right forearm
> and the right wrist.pulses are intact.? The arm bullet looks like it
> entered the right chest in the posterior axillary line. Chest tube drained
> 200 ml of hemothorax. There was also an entry in the right upper quadrant
> of the abdomen and one in the left flank at the posterior axillary line.
> Initially hypotensive, he responded? rapidly to a small amount of fluid
> and remained normotensive.
>
> Taken for exploratory laparotomy which was nontherapeutic. no inuries
> identified.
> A bullet subsequently found in the soft tissues of the abdomen, indicating
> a tangential abdominal wall injury. There was nonexpanding hematoma of the
> right thigh.
>
> postop chest and abdomen/ppelvis attached. Appears that left buttock
> bullet fractured the right femur
>
> Would a CT be of use here?
> What about angiography for the extremity wounds.
>
>
>
>
>
>
> sal sclafani
>
>

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