Who needs surgeons anyway J Patel A Wale

  • Slides: 10
Download presentation
Who needs surgeons anyway? J Patel, A Wale, J Barber, S Ameli-Renani, R Greenhalgh

Who needs surgeons anyway? J Patel, A Wale, J Barber, S Ameli-Renani, R Greenhalgh jaymin. patel@nhs. net Excellence in specialist and community healthcare

Clinical information § Helicopter emergency medical service (HEMS) referral by land § 37 yr

Clinical information § Helicopter emergency medical service (HEMS) referral by land § 37 yr old male § “Lorry driver slammed into another lorry at 40 mph” § Right sided chest pain HR 98 BP 110/65 mm. Hg

Clinical information § CT (split bolus arterial & portal venous phase) § 10 mins

Clinical information § CT (split bolus arterial & portal venous phase) § 10 mins after arrival

Clinical information § IR called and enroute § 1 hr later – unstable §

Clinical information § IR called and enroute § 1 hr later – unstable § Branches of right hepatic artery successfully embolised

Clinical information § Moved onto ward § 10 days later noted to be more

Clinical information § Moved onto ward § 10 days later noted to be more septic, jaundiced and breathless § Repeat split bolus CT: hepatic necrosis, larger collection in lesser sac, right pleural collection

Clinical information § US guided chest drain bile presumed diaphragmatic injury § US guided

Clinical information § US guided chest drain bile presumed diaphragmatic injury § US guided lesser sac drain purulent/faeculant content

Clinical information § ERCP: active biliary leak at the hilum of the right and

Clinical information § ERCP: active biliary leak at the hilum of the right and left biliary ducts – successfully stented

Final Diagnosis § Grade IV liver laceration § Successfully embolised by IR in the

Final Diagnosis § Grade IV liver laceration § Successfully embolised by IR in the acute setting § Grade IV extrahepatic biliary duct injury § Successfully stented by ERCP § Presumed diaphragmatic rupture § Conservative managment § Infected lesser sac biloma § Drained under ultrasound guidance

All is well that ends well. . . Discharged home and just started working

All is well that ends well. . . Discharged home and just started working again. Persistent: § Small pleural effusion § Aseptic intrahepatic biloma § Aseptic lesser sac collection

Discussion § Split bolus ‘trauma’ scans are essential in guiding appropriate management in haemodynamically

Discussion § Split bolus ‘trauma’ scans are essential in guiding appropriate management in haemodynamically unstable patients § Embolisation should be considered in isolated organ injury, despite severity § Biliary duct trauma should be suspected in high grade liver injuries § Non-invasive techniques can be used in select cases to reduce morbidity and hospital stay