[HSF] Acute abdomen plus unstable LM stenosis

[Tea Acuff]

Not to be nihilistic, but it is nearly impossible to convince a carpenter that a half driven nail that caught on his jeans and tore them does not need pounding. Perhaps if the ceiling is aflame over his head...but then again...
 
tea


----- Original Message ----
From: Nasser F. Abou'Seada <nfaabouseada at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Thursday, December 6, 2007 4:37:28 PM
Subject: Re: [HSF] Acute abdomen plus unstable LM stenosis

OK ..  A situation of concurrent Cardiac problem and acute abdomen   ....
what is the current status of opinion as regarding management plan and
priority / sequence of intervention, .... need to listen to our "thinktanks"
.... Bob, John, Tea, Tomas, Mark .... ?? ....

NFA

On Dec 6, 2007 1:39 PM, Dr. Roberto Battellini <battr at medizin.uni-leipzig.de>
wrote:

> Don,
> bad similar cases, on 27 of November I got a man 71 yrs old with
> decompensate AS, EF 35%,  and 2 vessel disease, had fever in the OR, we
> decided not to operate and wait. He was already intubated. He fibrillated
> after extubation, was reanimated and I had to go on. AVR Perimount 25 and
> bypasses to LAD and margina + Kryoablation. In the postop the ventricle
> had
> good function but lactate was high, before yesterday acute abdomen, the
> general surgeons opened him and found all small bowel and colon
> necrotic...end.
> I think there are concomitant vascular pathologies.
> Roberto
>
> -----Ursprüngliche Nachricht-----
> Von: openheart-l-bounces at lists.hsforum.com
> [mailto:openheart-l-bounces at lists.hsforum.com ] Im Auftrag von Donald Ross
> Gesendet: Donnerstag, 6. Dezember 2007 06:22
> An: OpenHeart-L at lists.hsforum.com
> Betreff: 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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