Podcast
Questions and Answers
What is the primary concern when evaluating pancreatic injuries?
What is the primary concern when evaluating pancreatic injuries?
- Figuring out if the pancreatic duct is involved (correct)
- Performing a Kocher maneuver to evaluate the pancreas operatively
- Determining if a Whipple or distal pancreatectomy is necessary
- Assessing for delayed signs such as fluid and necrosis
What may be necessary for a pancreatic head duct injury that is not reparable?
What may be necessary for a pancreatic head duct injury that is not reparable?
- Placement of drains only (correct)
- Distal pancreatectomy
- ERCP with stent placement
- Immediate trauma Whipple procedure
What is indicated by persistent or rising amylase levels in the context of pancreatic injury?
What is indicated by persistent or rising amylase levels in the context of pancreatic injury?
- Successful repair of the pancreatic duct
- Missed pancreatic injury (correct)
- Resolution of pancreatic hematoma
- Effective drainage of the pancreas
What imaging modality is poor at diagnosing pancreatic injuries initially?
What imaging modality is poor at diagnosing pancreatic injuries initially?
What is a major sign of extremity vascular injury?
What is a major sign of extremity vascular injury?
What should be considered for superficial femoral or popliteal artery injuries?
What should be considered for superficial femoral or popliteal artery injuries?
What can compartment syndrome lead to?
What can compartment syndrome lead to?
How should bleeding of the inferior vena cava be best controlled?
How should bleeding of the inferior vena cava be best controlled?
What should be done in cases where residual stenosis of the IVC is greater than 50% after repair?
What should be done in cases where residual stenosis of the IVC is greater than 50% after repair?
When should prophylactic fasciotomy be considered?
When should prophylactic fasciotomy be considered?
What is the most common organ injured with penetrating small bowel trauma?
What is the most common organ injured with penetrating small bowel trauma?
Intra-abdominal fluid not associated with a solid organ injury, bowel wall thickening, and mesenteric hematoma on abdominal CT scan is suggestive of injury to which organ?
Intra-abdominal fluid not associated with a solid organ injury, bowel wall thickening, and mesenteric hematoma on abdominal CT scan is suggestive of injury to which organ?
What is the recommended approach for small lacerations in the small bowel?
What is the recommended approach for small lacerations in the small bowel?
When should resection and anastomosis be performed for small bowel injuries?
When should resection and anastomosis be performed for small bowel injuries?
What should be done if there are multiple close lacerations in the small bowel?
What should be done if there are multiple close lacerations in the small bowel?
When should mesenteric hematomas be opened intra-operatively?
When should mesenteric hematomas be opened intra-operatively?
What is the recommended management for right and transverse colon injuries?
What is the recommended management for right and transverse colon injuries?
In cases of left-sided colectomy for destructive lesions, what is indicated for gross contamination, delayed repair, comorbidities, or significant blood transfusions?
In cases of left-sided colectomy for destructive lesions, what is indicated for gross contamination, delayed repair, comorbidities, or significant blood transfusions?
What is generally not recommended for rectal trauma?
What is generally not recommended for rectal trauma?
What is a potential management option for common bile duct injury?
What is a potential management option for common bile duct injury?
What is the treatment approach for intra-operative portal triad hematomas?
What is the treatment approach for intra-operative portal triad hematomas?
Study Notes
Trauma Surgery: Management of Colon, Rectal, Liver, Spleen, and Pancreatic Injuries
- Colon injuries: right and transverse colon injuries do not require diversion; left colon injuries may require primary repair without diversion for non-destructive injuries
- In cases of left-sided colectomy for destructive lesions, diverting ileostomy is indicated for gross contamination, delayed repair, comorbidities, or significant blood transfusions
- Rectal trauma: treatment varies based on location and type of injury, with different approaches for intraperitoneal, extraperitoneal, and low, middle, and high rectal injuries
- Presacral drains and rectal washout are generally not recommended for rectal trauma
- Liver trauma: common with blunt abdominal trauma, damage control peri-hepatic packing may be used for severe penetrating liver injuries if the patient becomes unstable in the OR
- Intra-operative portal triad hematomas and contained subcapsular hematomas require different approaches
- Common bile duct injury management depends on the extent and complexity of the injury, with options including repair over stent or choledochojejunostomy
- Portal vein injury requires repair, and ligation of the portal vein is associated with high mortality
- Omental graft can be used in liver laceration to control bleeding and prevent bile leaks
- Nonoperative management of blunt liver injuries is an option for stable patients, with specific criteria for transitioning to operative or angioembolization management
- Spleen trauma: splenic salvage is associated with increased transfusions, and the risk of postsplenectomy sepsis is highest within 2 years post-splenectomy
- Pancreatic trauma: penetrating injuries account for the majority of cases, and edema or necrosis of peripancreatic fat is indicative of injury; most injuries are treated with drains
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Description
Test your knowledge about diagnosing small bowel trauma, including the most common organ injured in penetrating injury, challenges in early diagnosis, and interpretation of abdominal CT scans. Learn about identifying occult small bowel injuries and the need for close observation.
