A case of multiple stab wound by Dr. Vijay Kumar Singh

Dr. Vijay Kumar is sharing a case of Multiple stab wound managed with great expertise by him. Share your views on the case & learn new things Follow us for more such updates!

98 Likes

LikeAnswersShare

Congratulations- Dr Vijay Kumar Singh for emergency management of a case of multiple stab wounds with splenic , hepatic and colonic injury and subsequent haemoperitoneum and faecal peritonitis- due to colonic perforation in Experts Insights case presentation. It saved an important life as surgical emergencies- if operated early is very important before severe septicaemia sets in .Only post - operative apprehension in colonic injuries is possibility of colonic repair disruption and faecal fistula . But a delayed oral feeds can help in preventing such complications. Then there is risk of complications due to excessive blood transfusion. The complications following splenectomy, including pneumonia pancreatitis, gastric fistula, gastric flatulence, and thrombocytosis, in patients with postoperative hemorrhage were significantly higher than those without hemorrhage (P < 0.001).. Any how - congratulations that this patient recovered without any complications Thanks

Valid points doctor. Thank you for the encouragement and insight. Much appreciated. 🙏
0

Thanks for inviting for discussion (don't know whether it is you or by curofy administration). Honestly,I had difficulty reading the small print of the slides. I wish to focus on two doubts that occured after reading the otherwise wonderful presentation. 1 .You recorded dull percussion note all over abdomen except over epigastrium and rt hypochondriac region . Absent liver dullness is Indicative of gas under the diaphragm which is due to perforation of a hollow viscous like stomach or intestine. No such finding is reported on laparatomy. If the clinical sign elicited is right,closer of abdomen without closing such perforation would have been disastrous .But the uneventful recovery is a proof against such event . Hence the clinical sign elicited is wrong . If the clinical sign preoperative given any importance,a plain X ray of abdomen in standing position should have been ordered which has not been done. Even if it is conceived that there could have beena small perforation of the gut which has spontaneously closed ,still such temporary seal if any cannot be left without closing. 2. The ABG report read a pH of 7. 1 which is on the acidic side and the serum Lactate is high ,indicating the cause of acidosis is due to lactic acidosis . A low hemoglobin and acidosis should have compromised tissue oxygenation,but nothing of such sort seems to have been observed in this case. Obviously,the pt was in shock and lactic acidosis should be anticipated and geared up to handle by the anesthetist who is a defacto critical care specialist on hand. Since ,the outcome is good, these questions might not be answered. If suppose the outcome is otherwise ..? "All is well that ends well" If any hole is in my analysis, please treat it as due to "Hole in my visual fields" ! I never got a feed back on issues raised in any of the expert opinions on which I commented so far.,I don't see any reason for departure in this particular case. Regards.

Thank you for the response Dr. Prasad. My apologies for a delayed response. I stopped following this post after the first couple of days and since I did not get any notification related to it, I missed the queries. Today, since I had time, I felt like looking it up and hence found your questions. I shall do my best to answer. (1st point regarding hollow viscus perforation). If you look at the last line of 2nd page in the treatment section --> two colonic perforations have been mentioned that were repaired. (2nd Point regarding Lactic Acidosis). A valid point doctor. In fact Metabolic acidosis is one of the three components of the "Trauma Triad of Death". All 3 cause and promote each other. Usually in trauma patients, along with hemorrhage, as the tissue perfusion worsens lactic acid accumulation occurs leading to acidosis which in turn worsens the situation. I understand that the usual question would be - why wasn't bicarbonate used to manage this acidosis? The acidosis in our case was effectively managed with blood transfusions alone. Though not the intended result, massive transfusions can have an undesirable shift of the oxygen dissociation curve to the left with an alkaline pH, thus it is suggested that bicarbonate therapy should be reserved for patients with severe metabolic acidosis (pH 7 or less). **In my defense, I had explained all these and many more points in the original presentation but it got a bit too long. Most of it had to be removed to fit the slide limit of 15. I hope I able to answer your queries.
0

View 1 other reply

Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Extraneous job done It was a medico-legal case with poor GCS Multiple stab injuries damaging vital organs like spleen and liver and perforating injuries to colon Pt in shock and hypotension Well timely assessment and management with crucial surgery and bt transfusions Pt was brought to life Hats off for dedicated work

Thanx dr Rakesh kayasth (pt)
0

View 3 other replies

10 to 12 yrs ago such case would be treated on the following line at dist hospital in haryana. We started from first controlling the bleeding and abdominal cavity should be packed with gauge piece and tight bandage applied around the abdo. A call to police in writing to arrange a judicial magistrate to record dying declaration at earliest with a calling letter to surgeon ,x ray ,blood incharge , emergency officer and nurses to monitor vital and oxygen ,iV Camila one or two as per requirement . Antibiotics, analgesic antiinflammatory and others types of fluid for electrolytes imbalance correction. Surgeon monitor and evaluate to shift pt to OT and show us injuries so we prepare ML report and surgeon write operative part and procedure and type of stitching and any special instructions we monitor the case every hourly and prognosis explained to attendents If pt in ICU we inform the police if they approach us. In castigation ,daily condition Post operative care so on. Now what happened I don't know due to pre mature retirement. Keep all record with you because you are suppose depose before judiciary ,.

Thanks Dr Dinesh Gupta
0

View 5 other replies

Very informative and educational study case of Multiple Stab Wounds to the Abdomen. Thanks for sharing useful presentation Dr Vijay Kumar Singh. It will add new chapter of knowledge booster to surgical procedures history.

Thanks Dr Rakesh Kayasth (pt)
0

View 7 other replies

Very nice case update Stab wounds can cause various internal and external injuries. They are generally caused by low-velocity weapons, meaning the injuries inflicted on a person are typically confined to the path it took internally, instead of causing damage to surrounding tissue, which is common of gunshot wounds.... Keep posting such cases...

Thank you doctor.
0

Trauma surgery.. Case profile patients.. Physical examination.. Investigation.. Emergency.. Treatment.. Management nice presentation thanks doctor..

Thanks doctor Narendra Kumar
1

View 8 other replies

CASE OF MULTIPLE STAB WOUNDS WHAT ARE THE SITES OF MULTIPLES STAB WOUNDS IS IT CHEST OR ABDOMEN THAT IS VERY IMPORTANT IN CHEST IS IT ON R OR L SIDE SAME IS TRUE ABOUT ABDOMEN HOWEVER.IF MULTIPLE STAB WOUNDS HAVE BEEN MANAGED IT IS CREDIT TO TGE SURGIUN FOR PROPMT MANAGEMENT

Thank you doctor 🙏 The stab wounds were to the abdomen only - both left and right.
0

MULTIPLE. STAB. .WOUNDS WITH HEMOPERITONEUM . .SEPSIS NICELY MANAGED THANKS. FOR. SHARING. DR

Thank you doctor. Much appreciated.
1

View 1 other reply

Load more answers

Cases that would interest you