[HSF] Acute abdomen plus unstable LM stenosis

[Michael Firstenberg]

what about IABP, medical management.... take out the dead colon and
hopefully the sepsis and myocardial demands would improve.

-m


On 12/6/07, Donald Ross <donross at bigpond.com> wrote:
>
> Hal,
> I certainly would have pushed for that if I had suspected a belly
> full of necrotic bowel.
> The poor fellow had more angina then abdo pain and in that situation
> it is hard for a cardiac surgeon to resist.
> Don
> On 06/12/2007, at 4:49 PM, hgrmd at aol.com wrote:
>
> > Don,
> > ? Could the patient have had a LM PCI?? That's one of the few
> > situations in which I would be in favor of it.
> >
> > Hal
> >
> >
> > -----Original Message-----
> > From: Donald Ross <donross at bigpond.com>
> > To: OpenHeart-L at lists.hsforum.com
> > Sent: Thu, 6 Dec 2007 12:21 am
> > Subject: Re: [HSF] Acute abdomen plus unstable LM stenosis
> >
> >
> > 70yr male with unremarkable past history presented with acute
> > abdomen and rest angina. ( WCC 20,000 )?
> > Urgent cath showed subtotal LM, 90% LAD, normal dominant RCA, good
> > LV function.?
> > Balloon placed and emergent cabg ( opcab rima to LAD and lima to OM.)?
> > Laparotomy next day revealed dead colon which was successfully
> > resected but patient fading fast with septic shock despite
> > haemofiltration.?
> > ?
> > Q1. Cause of dead gut in the absence of AF or infarct??
> > Q2. Timing of laparotomy : before, during or sooner after cabg??
> > Don?
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