this is an interesting case our hospital recently saw. i was not personally involved so i had the advantage of viewing it through the retrospectoscope from the beginning.
quick history. blunt abdominal trauma. abdomen completely soft.
for now that's all i'm saying. please give opinions, especially from surgeons. tell other surgeons to take a look. i'm sure someone should get the right diagnosis. (i'm purposely withholding one piece of information, but only because it was initially withheld from me and the surgeon on the floor didn't pick up on it.
Could be a ruptured diaphragm, or a pre-existing hernia of the congenital type. But since those are pretty obvious, I assume I'm missing something, too. The amount of tracheal shift and heart to the right suggests it's chronic and unrelated to the trauma, as in a congential hernia -- unless the patient was in extremis. I hate feeling stupid....
ReplyDeleteOK, let's have it, bongi.
ReplyDeletewas hoping for slightly more vibrant debate.
ReplyDeleteok. the surgeon on call, a cuban surgeon (the cuban government has a contract with our government to supply us with doctors) saw the patient and booked him for laparotomy, diagnosis ruptured diaphragm. at laparotomy, the diaphragm was intact, but he said it was paper thin, almost like no more than a peritoneal layer. it was essentially a negative lap.
when they presented the case, thinking myself quite clever (with the advantage of the retrospectoscope) i asked if the patient has had any previous trauma to the neck ir operation of the neck. no one had looked. on rounds, sure enough he had an old ugly scar on the anterior border of his sternocleidomastoideus, apparently after a stabwound of the neck about 5 years previously.
then i felt very clever. lq2m.
Well, at least I suggested it was chronic and unrelated to the trauma...
ReplyDelete