[HSF] Acute abdomen plus unstable LM stenosis

[Michael Firstenberg]

Oh, let us not forget the STS mortality for you and the "oh well, we lost
another dead gut" death for the general surgeon.

Although, hats off for at least trying and caring.....


-michael




On 12/6/07, Prasanna Simha M <prasannasimha at gmail.com> wrote:
>
> I agree. That is why I said that if you go on bypass with necrotic bowel
> you
> will have difficulty on bypass maintaining volume svr etc etc. (I meant do
> a
> laporotomy prior to CPB to check for dead bowel. If there is massive gut
> necrosis probably you may not oeprate the patient if he were to develop
> short bowel syndrome if there is no small bowel left to salvage -
> philosophical issue)
>
> On Dec 6, 2007 8:41 PM, Dr. Roberto Battellini <
> battr at medizin.uni-leipzig.de>
> wrote:
>
> > Prasanna,
> > many times it would be better fort he surgeon to know what is happening
> in
> > the abdomen...
> > Roberto
> >
> > -----Ursprüngliche Nachricht-----
> > Von: openheart-l-bounces at lists.hsforum.com
> > [mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von Prasanna
> > Simha
> > M
> > Gesendet: Donnerstag, 6. Dezember 2007 07:09
> > An: OpenHeart-L at lists.hsforum.com
> > Betreff: Re: [HSF] Acute abdomen plus unstable LM stenosis
> >
> > Colonic Ischemia due to mesentric artery stenosis - you can get
> mesentric
> > infarcts just like cardiac infarction and the two need not be temporaly
> > related.
> > Laparotomy prior to CABG as you will have a big problem on CPB with
> fluid
> > etc etc (also pays to look if you have massive gut necrosis when nothing
> > being done may at times be the therapy.
> > Prasanna
> >
> > On Dec 6, 2007 6:21 AM, Donald Ross <donross at bigpond.com> wrote:
> >
> > > 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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> > --
> > Prasanna Simha M
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>
> --
> Prasanna Simha M
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