Weekend cases:
Appy: Went home as outpatient (kid).
Appy: Stayed 3 days for no apparent reason.
Appy: Perfed, stayed three days (good reason).
Appy: Went home as outpatient (kid).
SBO (laparoscopic release!): Really sick and old, renal failure, doing well now but not home for a few more days probably.
The doozy was a late presentation of a perforated colon with massive feculent peritonitis and sepsis. Pre-op was in septic shock, in renal, respiratory, circulatory and liver failure: Did a Hartmann's after fluid rescuscitation. Did poorly as expected and died 48 hours later. Never cleared a significant lactic acidosis despite a full court press.
The moral: Treat infections in the abdomen early and you do much, much better. We still suck at treating full blown sepsis.
Random thoughts.
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