Injuries missed at operation: nemesis of the XXXX surgeon.

@entity1 @entity2332 @entity2293 @entity1003 @entity520 @entity1230 @entity1317 @entity551 @entity130
Injuries missed at initial operation have the potential to cause the most disastrous complications in @entity130 @entity1 . Over the past 5 years, 12 @entity1 have required re-operation for 14 injuries missed at initial laparotomy and/or thoracotomy. Six missed injuries were vascular, two each in the thorax, pelvis, and retroperitoneum. The other eight were visceral: three small bowel (one @entity1 ), two pancreatic, and one each of the heart, ureter, and diaphragm. Five @entity1 (42%) died, three with missed vascular and two with missed @entity130 . Three died due to complications directly related to their missed injuries, while the unrecognized injury did not play a significant role in the other two. Indications for re-operation in @entity1 with @entity1317 were @entity551 in two @entity1 , persistent output from drains in three, and refractory @entity520 in one. Re-exploration in @entity130 was for clinical sepsis in three @entity1 , DIC in one, @entity2293 in one, and persistent chest tube drainage in one. Eleven of the 12 @entity1 presented to the E.D. in shock. All @entity1 had @entity1230 with a mean of 3.25 organ systems injured. @entity551 , @entity1003 , and/or @entity2332 (T less than 92 degrees) were felt to have contributed to missing the injury in five of the @entity1 with vascular, and three of the @entity1 with @entity130 . In the four other @entity1 , injuries were missed due to inadequate exploration or a low index of suspicion in the presence of @entity1230 .(ABSTRACT TRUNCATED AT 250 WORDS)
