Slava,my friend,
She has a ruptured pancreas affecting the body and tail with an open Wirsung and other accesories ducts draining pancreatic juice into the retropancreatic space. A precocious pseudocyst is beginning to take form.
She has a ruptured pancreas affecting the body and tail with an open Wirsung and other accesories ducts draining pancreatic juice into the retropancreatic space. A precocious pseudocyst is beginning to take form.
Besides this, a severe traumatic lesion of the left kidney is visible and no function of it can be detected.
Besides this, a severe traumatic lesion of the left kidney is visible and no function of it can be detected.
So, I would not be excessively dubious in proposing an exploratory laparotomy intending to resect the distal pancreatic portion (distal pancreatectomy), suture of the proximal pancreatic stump,careful rainage of the collected post traumatic pseudo cyst and very careful exploration of the renal cell.
So, I would not be excessively dubious in proposing an exploratory laparotomy intending to resect the distal pancreatic portion (distal pancreatectomy), suture of the proximal pancreatic stump,careful rainage of the collected post traumatic pseudo cyst and very careful exploration of the renal cell.
If the traumatic lesion is not corrigible by means of hemostatic measures and NO function of it can be expected, left nephrectomy should be considered. The patient is young and previously healthy,I suppose so she would be in condition to support the surgical aggression. To my knowledge,there's is no place to medical observation or doing nothing as you quote as a possibility on your message.
If the traumatic lesion is not corrigible by means of hemostatic measures and NO function of it can be expected, left nephrectomy should be considered. The patient is young and previously healthy,I suppose so she would be in condition to support the surgical aggression. To my knowledge,there's is no place to medical observation or doing nothing as you quote as a possibility on your message.
Sincerely yours,
Sincerely yours,
Hernan
-– Original Message –
From: Dr. Nicolás
To: «SURGINET: General Surgery Discussion List»
Sent: Saturday, September 03, 2005 8:55 PM
Subject: Re: Another neglected blunt abd trauma
Slava
I would definetinely go for percutaneos drainage of the pseudocyst.
Regarding the kidney I would leave it alone for the time being…
I would not do a laparotomy in this patient unless hollow viscus lesion is confirmed with the aspiration of the pseduocyst, blunt duodenal lesion may be associated to pancreatic trauma and often neglected, tough call in this scenario.
Good luck