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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

Absite Topic ReviewGeneral Surgery

Nir Hus, MD, PhD.

Mount Sinai Medical Center

Miami Beach


Nir Hus


Diaphragm injuries
Diaphragm injuries chest pain. A CXR shows air-fluid levels in the chest. Yhe most appropriate next step in management is:

  • 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
Ureteral injuries chest pain. A CXR shows air-fluid levels in the chest. Yhe most appropriate next step in management is:

  • 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 injuries1
Ureteral injuries chest pain. A CXR shows air-fluid levels in the chest. Yhe most appropriate next step in management is:

  • 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 injuries2
Ureteral injuries chest pain. A CXR shows air-fluid levels in the chest. Yhe most appropriate next step in management is:

  • 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 injuries3
Ureteral injuries chest pain. A CXR shows air-fluid levels in the chest. Yhe most appropriate next step in management is:

  • Full transsection ureteral injuries can be divided into:

    • high/middle injuries (above the pelvic brim).

    • Lower injuries (below the pelvic brim).

Nir Hus


Ureteral injuries below the pelvic brim
Ureteral injuries chest pain. A CXR shows air-fluid levels in the chest. Yhe most appropriate next step in management is:Below 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


Ureteral injuries above the pelvic brim
Ureteral injuries chest pain. A CXR shows air-fluid levels in the chest. Yhe most appropriate next step in management is:Above 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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