After abdominal injuries like David Ortiz’s, infections are the big worry, doctors say
Patients who have undergone major abdominal surgery like Red Sox great David Ortiz must be closely monitored for signs of infection, according to two local physicians who deal frequently with gunshot wounds.
“Those are things that can usually be picked up on and treated,” said Dr. Reza Askari, assistant trauma director at Brigham and Women’s Hospital.
Ortiz underwent what the Red Sox described as exploratory surgery Monday night at Massachusetts General Hospital, a day after he was shot in the back in his native Dominican Republic. He had an initial surgery there to repair his small intestine, large intestine, and liver.
People can safely lose portions of their intestines, as Ortiz reportedly did. But the reconnected bowel can leak, leading to severe infections, said Dr. Michael P. Hirsh, a trauma surgeon at UMass Memorial Medical Center.
“Hopefully Mr. Ortiz won’t suffer that,” Hirsh said. “He’s not out of the woods as far as the natural history of these things for at least another week.”
Both doctors stressed that they have no direct knowledge of Ortiz’s care, and Mass. General has declined to comment on his treatment.
The care team most likely is taking regular blood tests, to check for a reduction in red blood cells, a sign of internal bleeding, or an increase in white blood cells, a sign of infection, Hirsh said.
Doctors and nurses will also probably be concerned about Ortiz’s breathing.
“Because he has a big incision and because the location is just under the diaphragm,” Hirsh said, “he’s probably not taking as deep a breath as he’d like to.” Shallow breathing increases the risk of pneumonia, but physical therapy can help expand the lung if needed, he said.
Ortiz probably has a pulse oximeter on a finger to measure oxygen levels in his blood, and he may be getting supplemental oxygen, Hirsh said.
Reportedly doctors in the Dominican capital, where Ortiz was shot at a bar Sunday evening, removed his gall bladder, an organ people can live well without. But it’s unclear what happened to his liver.
“The trajectory of [a] bullet is one that can cause internal damage within the substance of the liver,” Hirsh said. The bullet also went through clothing, potentially bringing in debris that can lead to infection. Although the liver itself can regenerate, the bile ducts that carry fluids to aid digestion are more fragile and can leak if damaged. “It’s a set-up for infection and bleeding,” Hirsh said.
Hirsh said that often with severe trauma, the first surgical team will stop the bleeding, remove damaged tissue, and stabilize the patient but “not do anything too fancy.” Instead, they wait for healing to start, and then surgeons go back in to make sure nothing is bleeding, remove the packing, and do more definitive surgery.
“That’s what we call a second-look operation,” he said.
Ortiz is lucky that the shooter didn’t aim closer to the middle of his back, where the bullet could have hit a major blood vessel or his spine, Hirsh added. “It’s pretty miraculous to survive a shot at point-blank range like this.”
Askari, the Brigham trauma surgeon, saw positive signs.
“He obviously needed immediate attention, which looks like he was able to receive. He was stable enough to be transferred,” Askari said. “Everything, as far as we can tell, has gone as well as can be expected.”
Hirsh agreed. “He’s definitely in critical condition, but he’s got the advantage of being only 43. He’s a very robust guy. He’s a fighter — we know that.”
Hirsh noted the coincidence that Ortiz was shot the night before Massachusetts General Hospital announced a new program to prevent gun violence.
Massachusetts, with tight gun regulations, has the lowest gun fatality rate in the country, Hirsh said. “But we’re surrounded by states with much looser controls and higher rates of fatality,” he said. “I’d like to see something good come out of something horrible like this.”