(for all cases follow link)
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Patient Name: |
MB |
Age |
20 |
Sex |
M |
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Diagnosis: |
Blunt abdominal trauma after motor vehicle accident. Severe head trauma and perforated small bowel that was diagnosed on the 5th day after trauma. Diffuse peritonitis. This case has been photo-documented. |
APACHE II Score |
15 |
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Operation |
Date |
What Was Done |
Predicted Mortality |
35% |
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STAR Entry 1 |
15-Aug-yy |
Suture of small bowel perforation, decompression, debridement, abdominal washout, packing, burr inserted to close the abdomen |
# Days with 1st Burr |
9 |
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STAR Entry 2 |
18-Aug-yy |
Inspection of repair, decompression, debridement, abdominal washout, packing, burr closure |
# Openings with 1st Burr |
5 |
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STAR Entry 3 |
19-Aug |
Decompression, debridement, abdominal washout, packing, burr closure |
# Days with 2nd Burr |
-- |
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STAR Entry 4 |
21-Aug |
Debridement of huge amounts of blood and many clots because the patient had experienced a hemothorax from inadvertent puncture of subclavian artery, required 8 units of blood, and became coagulopathic. Multiple blood clots were removed from the abdominal cavity because they would have been “good for abscess formation nutrient.” Decompression, debridement, abdominal washout, packing, burr closure |
# Openings with 2nd Burr |
-- |
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STAR Entry 5 |
22-Aug-yy |
Bowel wall suture, decompression, debridement, abdominal washout, packing, burr closure |
# Days from Burr application to definite wound closure |
9 |
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STAR Entry 6 |
24-Aug-yy |
Decompression, debridement, abdominal washout, burr removed, abdominal fascia closed, skin stapled. |
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OUTCOME |
Alive |
Yes |
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# Openings/day |
1.5 |
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Hernia |
No |
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44. STAR CASES 19yy
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Patient Name: |
KM |
Age |
71 |
Sex |
M |
|
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Diagnosis: |
Diffuse purulent peritonitis from two leaking colon anastomoses (following takedown of two colostomies) 14 days earlier, necrosis of two newly formed colostomies 8 days earlier, and leaking 20 cm gastroduodenostomy (performed 2 days prior to the first STAR entry) for massive upper gastrointestinal hemorrhage from stress ulcers. Multiple organ failure, massive upper gastrointestinal tract stress ulcerations, abdominal compartment syndrome, obesity, ischemic heart disease, hypertension. This case has been photodocumented. |
APACHE II Score |
29 |
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Operation |
Date |
What Was Done |
Predicted Mortality |
89% |
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STAR Entry 1 |
12-Aug-yy |
Abdominal decompression. (Bowel had necrotic spots from insufficient blood supply) Reclosure of gastroduodenostomy and removal of T-tube drain from duodenum, irrigation and debridement, closure of lateral transfers closure of lateral abdominal wall incision that had been made to gain access to the duodenum in this very obese patient, abdominal washout, packing, burr inserted to close the abdomen |
# Days with 1st Burr |
11 |
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STAR Entry 2 |
13-Aug-yy |
Resection of the necrotic colostomy. Decompression, debridement, abdominal washout, packing, burr closure |
# Openings with 1st Burr |
11 |
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STAR Entry 3 |
14-Aug-yy |
Resection of the leaking distal colon anastomosis (2/3 of the circumferene was disrupted) both ends were stapled off. Decompression, debridement, abdominal washout, packing, burr closure |
# Days with 2nd Burr |
-- |
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|
STAR Entry 4 |
15-Aug-yy |
Closure of duodenotomy, resection of descending colostomy, no anastomosis. Decompression, debridement, abdominal washout, packing, burr closure |
# Openings with 2nd Burr |
-- |
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STAR Entry 5 |
16-Aug-yy |
Colorectostomy with EEA 32 stapler, closure of duodenal leak, the remaining descending colon has been stapled off and left in situ for the time being. Decompression, debridement, abdominal washout, packing, burr closure |
# Days from Burr application to definite wound closure |
11 |
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STAR Entry 6 |
17-Aug-yy |
Decompression, debridement, abdominal washout, packing, burr closure |
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STAR Entry 7 |
18-Aug-yy |
Left hemicolectomy. Decompression, debridement, abdominal washout, packing, burr closure |
Alive |
Y |
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STAR Entry 8 |
19-Aug-yy |
Decompression, debridement, abdominal washout, packing, reapproximation of fascia, burr closure |
# Openings/day |
1 |
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STAR Entry 9 |
21-Aug-yy |
Resuture of duodenal leak, decompression, debridement, abdominal washout, packing, reapproximation of fascia, burr closure |
Hernia |
N |
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STAR Entry 10 |
22-Aug-yy |
Decompression, debridement, abdominal washout, packing, reapproximation of fascia, burr closure |
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STAR Entry 11 |
23-Aug-yy |
Decompression, debridement, abdominal washout, burr removed, abdominal fascia closed, skin stapled |
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45. STAR CASES 19yy
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Patient Name: |
SM |
Age |
44 |
Sex |
M |
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Diagnosis: |
Diffuse suppurative peritonitis from perforatated diverticulitis |
APACHE II Score |
30 |
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Operation |
Date |
What Was Done |
Predicted Mortality |
83% |
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STAR Entry 1 |
9-Oct-yy |
Sigmoidectomy, no anastomosis, no colostomy. Colon end stapled off and anastomosis deferred until patient hemodynamically stable and out of septic shock. Decompression, debridement, abdominal washout, packing, burr inserted to close the abdomen |
# Days with 1st Burr |
3 |
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STAR Entry 2 |
10-Oct-yy |
Colorectal end-to-end anastomosis. Decompression, debridement, abdominal washout, packing, burr closure |
# Openings with 1st Burr |
4 |
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STAR Entry 3 |
12-Oct-yy |
Decompression, debridement, abdominal washout, packing, burr closure |
# Days with 2nd Burr |
-- |
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STAR Entry 4 |
13-Oct-yy |
Decompression, debridement, abdominal washout, packing, burr removal and fascial closure |
# Openings with 2nd Burr |
-- |
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|
# Days from Burr application to definite wound closure |
4 |
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Alive |
Y |
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# Openings/day |
1.2 |
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Hernia |
N |
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46. STAR CASES 19yy
|
Patient Name: |
BM |
Age |
27 |
Sex |
M |
|
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Diagnosis: |
Diffuse suppurative peritonitis from anastomotic leak and recurrent bowel ischemia 7 days after resection of ischemic bowel. Bowel ischemia due to strangulation. Paraplegia, ileum conduit with neobladder. Pelvic decubitus and bone infection |
APACHE II Score |
16 |
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|
Operation |
Date |
What Was Done |
Predicted Mortality |
39% |
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|
STAR Entry 1 |
16-Nov-yy |
Resection of necrotic bowel and anastomosis. Decompression, debridement, abdominal washout, packing, burr inserted to close the abdomen |
# Days with 1st Burr |
4 |
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STAR Entry 2 |
18-Nov-yy |
Resuture of a new anastomotic leak. Decompression, debridement, abdominal washout, packing, burr closure |
# Openings with 1st Burr |
3 |
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STAR Entry 3 |
19-Nov-yy |
Inspection, decompression, debridement, abdominal washout, packing, burr closure |
# Days with 2nd Burr |
-- |
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STAR Entry 4 |
20-Nov-yy |
Debridement, abdominal washout, burr removed, abdominal fascia closed, skin stapled |
# Openings with 2nd Burr |
-- |
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|
|
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# Days from Burr application to definite wound closure |
4 |
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Alive |
Y |
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|
|
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# Openings/day |
1.3 |
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|
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Hernia |
N |
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47. STAR CASES 19yy
|
Patient Name: |
PC |
Age |
40 |
Sex |
M |
|
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Diagnosis: |
Diffuse peritonitis due to small bowel perforations, 7 days after right hemicoletomy for suspected source for GI tract hemorrhage. Status post repair of aortoenteric fistula in 1987 and repair of a perforating injury to the aorta and vena cava in 1972. |
APACHE II Score |
14 |
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|
Operation |
Date |
What Was Done |
Predicted Mortality |
32% |
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|
STAR Entry 1 |
4-Dec-yy |
Wedge resection of multiple small bowel perforations and suture. Decompression, debridement, abdominal washout, packing, burr inserted to close the abdomen |
# Days with 1st Burr |
12 |
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STAR Entry 2 |
6-Dec-yy |
Decompression, debridement, abdominal washout, packing, burr closure |
# Openings with 1st Burr |
11 |
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STAR Entry 3 |
7-Dec-yy |
Decompression, debridement, abdominal washout, packing, burr closure |
# Days with 2nd Burr |
-- |
||
|
STAR Entry 4 |
8-Dec-yy |
Reapproximation of fascia. Decompression, debridement, abdominal washout, packing, burr closure |
# Openings with 2nd Burr |
-- |
||
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STAR Entry 5 |
9-Dec-yy |
Reapproximation of fascia. Decompression, debridement, abdominal washout, packing, burr closure |
# Days from Burr application to definite wound closure |
12 |
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STAR Entry 6 |
11-Dec-yy |
Decompression, debridement, abdominal washout, packing, burr closure |
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STAR Entry 7 |
12-Dec-yy |
Suture of a new bowel perforation. Decompression, debridement, abdominal washout, packing, burr closure |
Alive |
Y |
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STAR Entry 8 |
13-Dec-yy |
Decompression, debridement, abdominal washout, packing, burr closure |
# Openings/day |
1.1 |
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STAR Entry 9 |
14-Dec-yy |
Decompression, debridement, abdominal washout, packing, burr closure |
Hernia |
N |
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STAR Entry 10 |
15-Dec-yy |
Decompression, debridement, abdominal washout, packing, burr closure |
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|
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STAR Entry 11 |
16-Dec-yy |
Decompression, debridement, abdominal washout, burr removed, abdominal fascia closed |
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