Académique Documents
Professionnel Documents
Culture Documents
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:
A. B. C. D.
Exploration through the abdomen. Exploration through the chest. Chest tube Percutaneous drain
Nir Hus
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
Ureteral injuries
A. B. C. D.
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
Ureteral injuries
A. B. C. D.
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
Ureteral injuries
A. B. C. D.
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
Ureteral injuries
Full
Nir Hus
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
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.
If
more than 2 cm are missing, place a percutaneous nephrostomy tube and tie off both ends of the ureter.
Nir Hus