|
Ok, so now what?
Well, with the evisceration in the thoracoabdominal region, I suspected that the diaphragm had been violated by the knife (lacerated the diaphragm) and that is why the omentum from the abdomen went through the lacerated muscle into the chest and then out of the chest wall to the outside.
This next photo (labelled) shows the omentum going through the diaphragm muscle and into the chest. See my hand holding back the small and large bowel and mesentry as a metal retractor lifts the abdominal wall up so we can take a photo. See the omentum going through the diaphragmatic laceration.
I repaired this by pulling the omentum back into the abdomen, closed the diaphragm laceration with suture, explored the rest of the abdomen for more injuries (none found) and closed the abdomen. I left the chest tube in until the lung sealed with no airleak in the pleuravac cannister and had a nomal chest x-ray.
Patient did fine and left a few days later.
Thoughts?
D-
|