Clinical Situation

[trestles4u]

Two weeks ago, I saw a 29 yo w male involved in an MVA. No witnesses or history of what happened except that he was very drunk. Initially BP was 70 P 88. After 1500 cc of RL his BP was 120, P 80. He had abrasions over the RUQ and a fxd L tenth rib. CT showed a large hemoperitoneum with a Grade III liver laceration. I watched him, transfused two units of PRBC'c on day 4 for a Hct of 19 and d/c'd him on day ten. He had one temp spike of 101 on day 5 and evidence of a R pleural effusion that I tapped for 1500 cc of old bloody fluid. He returned on the 13th post trauma day with a fever of 101.6, a large r pleural effusion and a WBC of 16,000. After fluid, WBC was 9,000, CT showed less intrabdominal fluid and a healing liver. Thoracentesis showed the same bloody fluid with a Bilirubin of 20. HIDA scan shows a small leak in the liver collecting in the LUQ. I can't find much written on Bile leaks in this situation. My inclination is to watch him as he is stable and afebrile. Any comments?

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[mcwmark]

Interesting...

Date: Tue, 20 Aug 1996 10:06:52
From: Philip Peverada [[email protected]]
Two weeks ago, I saw a 29 yo w male involved in an MVA. No witnesses or history of what happened except that he was very drunk. Initially BP was 70 P 88. After 1500 cc of RL his BP was 120, P 80. He had abrasions over the RUQ and a fxd L tenth rib. CT showed a large hemoperitoneum with a Grade III liver laceration. I watched him, transfused two units of PRBC'c on day 4 for a Hct of 19 and d/c'd him on day ten. He had one temp spike of 101 on day 5 and evidence of a R pleural effusion that I tapped for 1500 cc of old bloody fluid. He returned on the 13th post trauma day with a fever of 101.6, a large r pleural effusion and a WBC of 16,000. After fluid, WBC was 9,000, CT showed less intrabdominal fluid and a healing liver. Thoracentesis showed the same bloody fluid with a Bilirubin of 20. HIDA scan shows a small leak in the liver collecting in the LUQ. I can't find much written on Bile leaks in this situation. My inclination is to watch him as he is stable and afebrile. Any comments?

Date: Tue, 20 Aug 1996 15:38:34
From: Bruce Bodnor [[email protected]]
Bravo for your restraint and steadfast clear thinking with this patient. It is so easy to be rushed to "operate!" on blunt trauma, then find a very hard to manage liver laceration that could have been left alone to tamponade. Now I guess you could wait, though I suspect a CT guided drain will be needed, and more waiting.

http://www.trauma.org/archives/livert.html

 

[eyedea]

LOL caught in a lie?

 

[doughboy]

Trestles4u, you are one strange cookie.....what have you got to say?

 

[trestles4u]

Yes, it is an interesting case...I thought it was provoking, so I reposted it here as well. So what is your opinion about the management of this case?

 

[Djanaba]

You're right, it's interesting, but the underlying key is that you should not pass this off as your own case.

No one ever stuck a drain in him???