1 / 9

Absite Topic Review General Surgery

Absite Topic Review General Surgery. Nir Hus, MD, PhD. Mount Sinai Medical Center Miami Beach. A 25 yo man comes to the office 3 months post an MVC w/ L chest pain. A CXR shows air-fluid levels in the chest. Yhe most appropriate next step in management is: Exploration through the abdomen.

percy
Download Presentation

Absite Topic Review General Surgery

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Absite Topic ReviewGeneral Surgery Nir Hus, MD, PhD. Mount Sinai Medical Center Miami Beach

  2. A 25 yo man comes to the office 3 months post an MVC w/ L chest pain. A CXR shows air-fluid levels in the chest. Yhe most appropriate next step in management is: • Exploration through the abdomen. • Exploration through the chest. • Chest tube • Percutaneous drain Nir Hus

  3. Diaphragm injuries • The acute management of a diaphragmatic injury is to go through the abd. • In Pt. w/ delayed presentation >1 week, go through the chest because the pt. will have adhesions which you must take down through a chest incision. Nir Hus

  4. Ureteral injuries • A 25 yo man sufferes a GSW to the lower abd. On exploration, the ureter above the pelvic brim is transected w/ a 1cm segment missing. The most appropriate management of this injury is: • Reimplantation into the bladder. • Trans uretero-ureterostomy • Reanastomosis. • Percutaneous drainage. Nir Hus

  5. Ureteral injuries • A 25 yo man sufferes a GSW to the lower abd. On exploration, the ureter below the pelvic brim is transected w/ a 1cm segment missing. The most appropriate management of this injury is: • Reimplantation into the bladder. • Trans uretero-ureterostomy • Reanastomosis. • Percutaneous drainage. Nir Hus

  6. Ureteral injuries • A 25 yo man sufferes a GSW to the lower abd. On exploration, the ureter above the pelvic brim is transected w/ a 2.5cm segment missing. The most appropriate management of this injury is: • Reimplantation into the bladder. • Trans uretero-ureterostomy • Reanastomosis. • Percutaneous drainage. Nir Hus

  7. Ureteral injuries • Full transsection ureteral injuries can be divided into: • high/middle injuries (above the pelvic brim). • Lower injuries (below the pelvic brim). Nir Hus

  8. Ureteral injuriesBelow the pelvic brim • Complete transections below the pelvic brim are always treated w/ reimplantation into bladder. • This is because a cysto-ureteral anastomosis has a much higher success rate than a uretero-ureteral anastomosis, especially after trauma. Nir Hus

  9. Ureteral injuriesAbove the pelvic brim • Injuires above the pelvic brim (in the trauma setting) are handled in one of two ways. • If there is just a short segment missing (<2cm) then mobilize as much ureter as possible without devascularizing it and perform re-anastomosis. • Consider placing a stent in this situation. • If more than 2 cm are missing, place a percutaneous nephrostomy tube and tie off both ends of the ureter. • At a later date, a urologist can perform a uretro-ureter anastomosis or an ileal conduit. Nir Hus

More Related