# You won't get this one.  Status post Shotgun GSW.



## mycrofft (Jul 27, 2009)

Patient experienced short-range 20ga to the abdomen. Was rapidly transported to local teaching medical center where the destroyed rectus abdominus and lengths of bowel were removed and a long period of convalescence ensued, including developement of abscesses during outpt periods, and the pt's continued use of illicit drugs.

During serial visits to jail for minor offenses, stubbornly non-healing areas in the abdominal area were seen and treated with daily dressing changes, no obvious infection ensued but the wounds (in epithelial tissue rather than muscle and good strong scars) did not progress.
Finally on day three of an incarceration about eighteen months post hospitalization, one of these chronic little sites began to form a four mm mound like a pimple, the pt began to run a low grade fever and complain of localized then mor generalized pain near it, and it opened to reveal an embedded, dark-greenish fiberous and smelly little scrap. The pt was hospitalized and required another month recouperation.
1. What do you think the material in the lesion was?
2. For extra points, what did it smell like?

HINT: he was very delinquent in outpt followups and never completed them.


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## MendoEMT (Jul 27, 2009)

What color shirt was he wearing when he got blasted?  Possibly a bit that didn't get cleaned out?  Or a souvenier left over from surgery?  As for the smell.....  I don't care to speculate.


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## mycrofft (Jul 27, 2009)

*Good first try, going to go faster than I thought.*

The shirt color was immaterial (pun intended), it was cleaned out if there was any to begin with.
It was not from the initial lifesaving surgery.
BTW, the first time I saw an exposed severed forearm tendon it looked like a teeny bit of NuGauze..but that's a red herring.
Or is it? B)

You will heve it in three tries folks.
The smell was, ah, *prominent.*


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## MendoEMT (Jul 27, 2009)

Hmmmmmm........ Prominent huh? 

I'm guessing then that maybe he had a bitty lil' rupture somewhere in there and a bit of digested dinner made its way out....  spinach perhaps?


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## 8jimi8 (Jul 27, 2009)

marijuanna?!


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## MendoEMT (Jul 27, 2009)

Oh!  Good one!!


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## MendoEMT (Jul 27, 2009)

HA!!  Was he keeping a hidden weed stash in his wounds to keep it concealed?!


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## mycrofft (Jul 27, 2009)

*Not dope. Very close on the earlier guess.*

It smelled like excrement.


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## Mzcr (Jul 27, 2009)

I had an employee once whose wound from minor surgery kept getting infected..for a year. They finally tested and found out he had Munchausen's Syndrome and had been injecting fecal matter into the wound. After that, I don't think I'd be shocked by much.


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## mycrofft (Jul 27, 2009)

*Youch, that used to be a syndrome related to nurses and FUO.*

He caused it but not by his _*actions*_...


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## MendoEMT (Jul 28, 2009)

Okay, so the guy was crummy in completing his outpatient therapy, so through is _inaction_ he had..........     :glare:..........  poor muscle tone in/around the rectus sheath and wound up with a leaky something or other that filled his abdominal cavity with gunky putting him into septic shock????


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## Melclin (Jul 28, 2009)

Wound partially healed over a piece of dressing or debris of some kind? Worked itself out later? To easy. 

Piece of the body worked itself out? Colon? Ligaments?


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## John E (Jul 28, 2009)

*Easy...*

it was the wadding from the shotgun shell finally coming out.

John E.


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## mycrofft (Jul 28, 2009)

*Melclin wins!!*

We thougth about wadding but the material was woven.
The pt had not bothered to have the NuGauze strip packing removed from one of his abscesses, and it eventually festered and formed a tract from the small bowel to the surface.
Thanks for playing, have a nice morning, and try to slow it down and carpe diem.


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