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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.

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Absite Topic Review General Surgery

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  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

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