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Resurrection
My Nine Second
Comings
With heartfelt thanks to…
Carola, meine Frau, who with her first assessment and immediate declaration of
emergency, undoubtedly saved my life, and for her daily presence and love before,
during, and after my crisis.
My daughter Radha, who called me regularly to stay informed of my status, to keep
me in good spirits, to declare “I don’t want to lose you”, and to check my “out of
Australia” medical insurance status.
The emergency ambulance team who revived me and delivered me safely to
Dinkelsbühl (DE) hospital.
The most excellent doctors and Intensive Care team of Dinkelsbühl hospital who took
such great care of me. It was a pleasure to be in a very personal village hospital.
Hello Helmut et al. I’m sorry I don’t remember all of your names.
Agata and Dimar, both Russian friends of Carola, living in Rostock DE; Nadezhda
Koroleva and Vadim Korolev from Russia, who remotely diagnosed me and made
controls to treat the symptoms of my pain, and guided me through stepping out of the
foreign events leading to the situation. They saw things in me which I did not.
Two new and wonderful friends, Jan and Helma, who invited me into their home
without knowing me before-hand and cared for me for several days after my
discharge, then drove me 333km to Frankfurt airport.
Our TP Thai friends, all of whom made dedications for me and my health in the Thai
Buddhist traditions.
All you wonderful souls - Thailand Project participants from past and future, too
many to name here - who heard about my situation and sent me your best wishes,
and who made individual and group controls to restore my health. I felt your work.
Grigori Grabovoi, who made this Creator Knowledge available, with the express desire
that those who master it will pass it on to all humans, for the benefit of all. I know
they give you a difficult time Grigori, I know you will prevail, I send you my best
wishes at all times.
With love…
Maxwell
Contents
Experiences in other levels… ........................................................................................4
Europe, August/September 2012 .....................................................................................................4
Wildenstein, Baden-Wurttemberg, Deutschland .......................................................................................4
August 23, 2012 ...................................................................................................................................................4
August 29, 2012 ...................................................................................................................................................4
NDE 1, Uh Oh ..................................................................................................................................................................4
NDE 2 & 3, A Rough Ride ................................................................................................................................................5
NDE 4, Dinkelsbühl. Alles In Ordnung? Not Really.......................................................................................................5
August 30, 2012 ...................................................................................................................................................5
August 31, 2012 ...................................................................................................................................................5
The shit hits the fan… ..........................................................................................................................................6
NDE 5, Body Reconstruction ............................................................................................................................................6
The operation .......................................................................................................................................................6
NDE 6 ...............................................................................................................................................................................6
Three hours later ..................................................................................................................................................6
NDE 7 ...............................................................................................................................................................................6
September 2-11, 2012 ..........................................................................................................................................7
Leaving this existence… ......................................................................................................................................7
NDE 8, Really Gone, Into The Future I Believe ...............................................................................................................7
NDE 9, A Combination .....................................................................................................................................................7
The Grey Planet.....................................................................................................................................................................................7
The Grey Planet, Again .........................................................................................................................................................................7
The Many Coloured Spheres .................................................................................................................................................................7
The ZERO..............................................................................................................................................................................................8
It’s over, it’s over, it’s o-o-o-over, it’s over!.........................................................................................................8
September 11-13 ..................................................................................................................................................8
Wildenstein, September 13-16 ..................................................................................................................8
Thailand ....................................................................................................................................................9
September 17-19 ..................................................................................................................................................9
Nadezhda And Wadim Koroljov ........................................................................................................................................9
September 20........................................................................................................................................................9
Creator Knowledge ........................................................................................................................10
My take on this…...............................................................................................................................................10
This Knowledge is a must-have for everyone....................................................................................................10
The hospital report… .....................................................................................................................11
Deutsch… ..........................................................................................................................................................11
Diagnose: ........................................................................................................................................................................11
Therapie:.........................................................................................................................................................................11
Behandlung Und Verlauf:................................................................................................................................................11
Therapievorschlag: .........................................................................................................................................................12
Letzte Medikation: ..........................................................................................................................................................12
English… ...........................................................................................................................................................13
Diagnosis: .......................................................................................................................................................................13
Therapy: ..........................................................................................................................................................................13
Treatment And Course: ...................................................................................................................................................13
Recommended Treatment: ...............................................................................................................................................14
Last Medication: .............................................................................................................................................................14
Leaving this 3D existence… And returning… ❆ !
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Experiences In Other Levels…
Europe, August/September 2012
Wildenstein, Baden-Wurttemberg, Deutschland
After almost a month in Germany and Switzerland any many kilometres by train and car visiting
old and new friends, Max and Carola finally make it to Wildenstein to meet with Carola’s
Schwäbisch friends Jan and Helma, to catch up on what’s happening in each others’ lives, and
generally to rest. Wildenstein is so quiet and relaxed I declare that I will stay here. We take a
room in a small Gasthaus.
The pains in the ribs and spine had already begun in Thailand; I have a high tolerance to pain so I
ignored the warning signals. This technique has worked flawlessly throughout my life, so why
should I treat this differently?
August 23, 2012
The pain continues; Carola insists; I relent. She takes me to Dinkelsbühl hospital for a checkup.
The X-ray shows 2 vertebrae out of place and 2 distorted ribs. The doctor prescribes pain killers.
Returning to the Gasthaus, I rest to escape the pain and to reduce the pain killer intake.
Medication is not my thing.
My situation improves and I become lively again, except for 2 or 3 pain attacks each night. Sleep
is uncomfortable. I know something is NOT OK, but I think it’s related to the spine and ribs, and
I will have this all rectified in Thailand. I wasn’t aware of the damage I was doing through selfneglect.
Life continues, until…
August 29, 2012
NDE1 1, Uh Oh
I collapse in the bathroom with the knowledge that I am dying - it’s not so bad after all - I do not
lose consciousness nor leave my body, but lose all my strength… I lie on the floor in a pool of
vomited blood.
I have children, grandchildren, and Carola. I decide to not die - I stay in my body.
Also my father is approaching death at this stage in Australia, and I don’t want him to have a
shock which might tip him “over the edge”. (I did not see him nor speak with him again, he died a
few weeks later while I was recovering).
I struggle to my feet to take a shower. I don’t want to be seen like this. I can barely organise a
flow of water.
Carola arrives, sees, and calls the ambulance. It’s hopeless - I sit on the shower floor and do my
best with Carola’s help, to clean myself. Some strangers help me to bed.
The same doctor from Dinkelsbühl hospital attends. His greeting is a warm “Ah, Maxwell
Stirling.” I reply, “Igor.”
Already, he seems to be an old friend. “A drowning man will clutch at a snake” ☺.
Carola & I both feel very comfortable with him and know all will be well handled. We assume
1
NDE: Near Death Experience
© Maxwell Stirling, 10/2012!
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he’s originally Russian. Igor begins to work on me - the emergency hand-held saline drip bag. I
feel a little more composed now.
The emergency team carries me down two flights of stairs in an inflatable flexible stretcher. It’s
the only method they can use, there is no elevator. It’s a bumpy ride, and I feel shock coming on.
I no longer care about anything.
NDE 2 & 3, A Rough Ride
The roads in and around the very old village of Dinkelsbühl are built of cobblestone, I assume by
Roman invaders from Julius Caesar’s days, and are very rough. It’s a slow drive. I “die” (OBE) 2
twice during the ride to hospital - they stop the ambulance to revive me. I’m aware of taking a
different journey each time, into other realms, and again say “No! I do NOT die, I go back.”
Both times I regain consciousness to find the Ambulance team acting extremely concerned and
doing their best to revive me. I need to put them at ease. “Cold… Shock…” I say, and I can still
manage a smile. They smile.
NDE 4, Dinkelsbühl. Alles In Ordnung? Not Really.
I “die” again on arrival at the hospital, during the unloading. I don’t recall the journey through the
corridors. Again I decide to go back into my body.
I sleep, wake, sleep, wake, oh blessed sleep and rest, so nice.
I hear talk of an endoscopy and sleep again. They allow Carola in the examination room with me,
an exception to their rules, because they need to be sure of good translation for information
exchange. At this stage all of my limited German is gone. I only recall waking while the doctor
inserts the camera-on-a-probe and quickly fall asleep again before they finish. I see about 2
seconds worth of my internals on a display. They locate but cannot treat the source of the blood
release, it is out of the reach of the endoscope.
The doctor decides to wait, as after the endoscopy and blood pumping, it appears that I am
recovering, and that the bleeding has stopped.
So now I’m in a bed in Intensive Care, hooked to blood and nutrient infusions. They say I lost
more than half of my blood supply, and was three hours maximum from physical termination.
August 30, 2012
Recovering and improving. Carola is busy with many things, she has a full plate, and now this on
top. She spends about half the day with me and half on her work. The general consensus among
the doctors is that my crisis is over, but they want to do another endoscopy later to be sure all is
well.
August 31, 2012
Carola has a dilemma - she flies to Thailand soon - and decides to postpone. I talk with her about
this - she has organised a seminar beginning on September 10, with 34 EU & AU participants, 2
Russian presenters, 2 translators, and a Thai team of around 18. A nightmare to re-organise.
I say she must return, I will follow as soon as I’m able. She’s not happy and wants to cancel the
seminar. I insist several times and she finally accepts; there is much preparation to finalise before
the seminar begins.
2
OBE: Out Of Body Experience
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The shit hits the fan…
The doctors want to do another endoscopy, they are uncomfortable about not treating the source of
the internal bleeding, so they prepare me for another throat-scope, and wheel my bed to the
examination room.
NDE 5, Body Reconstruction
While waiting in bed in the corridor for a examination room vacancy, I lose 3D consciousness
again for a short time. Visiting another realm, I again state very clearly to myself “No!”. I know
I’m in trouble, that I must go to my Point of Reconstruction. The thought alone takes me there
where I immediately instruct my eternal body cells “Reconstruct my body!”. They do. I am back
in my body and wake to find everyone in a panic, so again I have to demonstrate that I am still
here - but I am so weak… The bleeding had re-commenced.
The operation
During the endoscopy the doctor controls the bleeding source and declares an operation is
necessary. I am given no choice now - well not exactly true - they give me the choice of “operate
or ………” . The damage is severe, life threatening.
NDE 6
I agree to the operation - actually Carola agrees, I gave her the authority. I am consciously gone
again, having yet another “other realm” experience. No, I decide to return again.
Awakening, I manage to say to Carola, “We see each other again in Chiang Mai.” She has
different aspirations, “No,” she says, “after the operation.” The surgeons have me now, I am
under anaesthetic, she must leave the operating theatre and wait.
I remember nothing of the operation, narcotics work well. ☺
Three hours later
The operation is successful, they reseal me and stitch the wound. At some stage I regain enough
awareness to experience my surroundings, in what has become my room by now (possession is a
strange beast).
Everything is vague, I slip in and out of sleep for short periods. Carola watches, whispering to me
all the while. It really is intensive care, doctors and nurses continually hovering, adjusting the life
support connections and all the drip medications.
After receiving so much foreign blood I wonder who I am now. It’s funny what you can think of
when you’re strange.
Happily, I have no idea I’m on a breathing machine with my hands fastened to the bedsides lest I
try to remove the breathing tube.
Carola keeps watch, is saddened by my imprisonment, and waits. I don’t see her.
NDE 7
I’m told I was put into artificial coma for 3 days, but I shortened it to 1.5 days, by, and I don’t
know how many times, consciously continuing to return from the other realms I was visiting. I
recall on one occasion using the Periodic Table of The Elements to rebalance my body chemistry
after so much artificial medication. Even when in coma, soul, spirit and consciousness are fully
alert, accurate, specific, and prepared to recreate each body cell to its design state. Spirit waits
only for our command.
© Maxwell Stirling, 10/2012!
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Carola waits… and waits… and begins to reorganise my flight.
September 2-11, 2012
Out of coma. No breathing machine, no throat tubes. I remember nothing of it.
It’s crunch time, now Carola must decide. I help her by remaining unconscious and nonparticipatory; the doctors say I am fine now and will recover. She says her goodbyes; the last she
sees of me I am hiding behind a mass of tubes. She feels more comfortable with the doctors’
assurances, but is not happy to leave.
She says “You were right, we see each other in Chiang Mai”. I don’t hear.
I do not see her again in Germany. She held it together so well. I’m happy she wasn’t here for
what followed. It would be difficult to explain it all while under drugs. Some things are best left
unsaid. (She knows now of course).
Carola leaves, unhappily. “Love won’t leave you alone” Freddie Mercury
Leaving this existence…
Now the experiences really kick in, triggered by hallucinations on the wall in front of me. I
remain fully conscious while out of my body.
I lose track of time, I have no memory of the dates.
NDE 8, Really Gone, Into The Future I Believe
I view the universe, noticing certain parts (stars, solar systems, galaxies) which stand out and are more
attractive than the rest. I take these parts and place them in my body in certain key points unknown to
me before and now. I simply know what to do automatically. I have become bold now, I know this is
good for me, the universe is my friend and my creation. I scan my body and take those parts which look
out of order, and place them in the attractive areas of the universe. This all feels so right.
I am free. I see things and places I cannot describe, they have no Earth language equivalent, purely
images in motion, different pulses and intensities of light, natural non-Earthly substances, geometric and
non-geometric shapes (blobs?), things I have not seen before. Some I see for a fleeting second, others a
little longer, it all passes before me, flash flash flash, like an epilepsy episode. It’s beautiful to behold. I
cannot say for how long this continues. It is pure recreation, plain and simple.
Without making any decisions, I’m back for more sleep.
NDE 9, A Combination
The Grey Planet
The wall shimmers, is entirely grey, and transforms into a lifeless planet.
The surface is grey, organic dirt, pock marked, no vegetation. Imagine you are looking at the twilight
zone of the moon. It is NOT the moon. This planet is not in this plane, it has it’s own existence. Later,
in Thailand, Nadezhda had something to say about this planet.
I’m viewing from inside a “transport ship” through a porthole, as a passenger would from the aisle seat
in an aeroplane. I see the planet has a narrow ring and realise I’m viewing it from the “south”. It’s
immense, I see nothing but planet.
I’m the sole passenger. On returning to my body and some reflection on this experience, I wonder if
I’m the pilot or the commander.
The Grey Planet, Again
It’s the same grey planet, this time I have more clarity. I’m in the transport ship, but it’s a different
experience. This time my view is unobstructed by a porthole, I see the through the ship’s hull. My
vision is 360°, inside and outside, an empowering feeling. Wherever I look I know I can go there. I am
unwilling to go further, unwilling to stay, I decide to return to my body, and I’m back immediately. The
Grey Planet is but a memory. Sleep…
The Many Coloured Spheres
It’s very clear to me - I’m leaving this existence level.
© Maxwell Stirling, 10/2012!
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In front of me are many spheres of different sizes and colours; red, blue, violet, yellow, green, orange,
some contain multi coloured bands - I notice there are no browns, greys, or blacks.
I walk/float/teleport through and between them, always forwards. I’m not sure of the motion, it seems
as if I simply look at my next destination and I’m there.
I know what is happening, that I’ve left my body big time - these are my own creations to bring me back
into this dimension. I caress these spheres with my vision and I’m filled with a beautiful feeling of love
and complete relaxation. I decide to go back, and I am back - in an instant. Sleep…
The ZERO
Leaving my body again. In front of me I see the bright outline of a ZERO, like a smoke ring in motion,
slightly larger than I am, and realise I need it desperately. This OBE is serious.
I know the meaning of the ZERO - transformation and changing dimensions, a 2-way portal. I ask
myself “Is this it? Is my Earth life finished? Am I being taken away?”. Then I remember that I create
everything, even the ZERO, so it is my tool and it will do what I want.
I decide to go back. The ZERO is hollow. Realising I am now on the “wrong” side of the ZERO I step
through it, and I’m immediately back in my body. Sleep…
It’s over, it’s over, it’s o-o-o-over, it’s over!
There are no more “out of body” experiences after this, I know I’ve survived.
I continue to recover daily. My spirits rise, my wound improves. I regain physical abilities. With
help I walk the hospital floors to regain lung and muscle strength, and co-ordination.
Every day, I am impressed by and grateful for the close personal attitude and actions of the
individual staff with whom I have contact. Care is definitely their motto. If you absolutely must
have an emergency - not recommended - Dinkelsbühl is the place to do it.
Jan enters the picture and visits me daily. He is such a lovely, life-intelligent man and we have
very interesting “not run of the mill” conversations. He speaks excellent English. We share our
life experiences.
All is good in Dinkelsbühl.
September 11-13
I am now out of Intensive Care, in a recovery ward, alone thankfully. Jan continues his daily
visits. He offers to smuggle nice food in for me. I decline, deciding to trust the hospital regimen.
This is very unusual for me, I like to please myself.
The doctors who assess me daily are impressed by my condition. The physiotherapists teach me
correct breathing again. I did not forget how, it was only a matter of lung strength.
Wildenstein, September 13-16
September 13th, the stitches are removed, and they release me. Jan checks me out of hospital and
brings me to his home where Helma greets me and takes me to my room. I meet their two sons,
Amadeus and Arian.
They take excellent care of me for 3 more days although they both have very busy lives. I overdo
it with the Laugenbrezel, I cannot resist. It is a beautiful feeling to have a home life again.
Jan drives me to Frankfurt airport on September 16. 333 kilometres. Alone again and physically
very uncomfortable, I know I’ll make it safely. The 2 flights to Chiang Mai are very
uncomfortable.
© Maxwell Stirling, 10/2012!
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Leaving this 3D existence… And returning… ❆ !
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Thailand
September 17-19
I arrive in Thailand in a weak condition on September 17 - Carola greets me in Chiang Mai airport
- and go straight to bed when home and sleep until next afternoon.
Next evening (18th) I go to dinner with the seminar participants, most of whom I know from
various prior seminars. Their greetings are amazing, they had been making so many controls for
me during their seminar. I make a speech, welcoming all, especially Nadezhda and Vadim.
Cheekily, (it was the eighth seminar day), as it’s my wish, I declare the seminar Open. Much
laughter and applause. Tears flow on both sides.
Nadezhda And Vadim Koroljov
Here I meet Nadezhda and Vadim for the first time. They are both direct students of Grigori
Grabovoi, extremely clairvoyant, healers, and present the Creator Knowledge in their own way in
Russia and Germany. This is their first time outside of Europe, they love it here, they love
presenting the seminar and they love the participants’ advanced understanding. They say we are
all special. Particularly Carola for transporting this Creator Knowledge so clearly to so many.
We are familiar with each other due to the remote healing they performed on me on August 5th and
6th while Carola and I were in Rostock, and we spend some time re-establishing our connections.
They had viewed then that I have 2 damaged ribs and 2 vertebra out of alignment, later confirmed
by X-ray, and had told me that I must seriously step out of the events leading to the damage. I met
Agata for the second time and Dimar for the first in Rostock.
We have a “chat” about my condition; they both make Creator Knowledge controls, adjustments
to my psyche and thinking processes, and tune my body, all to ensure I make full and swift
recovery. The chat resembles a gentle inquisition. ☺
The evening of the 19th I go to the participants’ farewell party, and stay too long, I’m very tired
and both stomach and wound begin to hurt. Wrong food and drink. I must leave.
September 20
Nadezhda and Vadim visit, “the healing is not finished,” they explain, “now we get serious.” This
time it’s definitely an inquisition. They want all my information. Anna and Helena translate.
Agata, Brian and Marion listen in.
In brief, I tell them everything I’ve told above. They are both very interested in the Grey Planet,
saying that I’m the last representative from this one, destroyed during the Star Wars. So, I think,
“Conceptually, the movie was real”. (This also coincides with Valentina’s - another direct student
of Grabovoi and clairvoyant healer - previous assessment that I must resurrect my entire
civilisation - I’m the last). They say there is no help for me on Earth from my civilisation, I’m the
last, and that I should not visit the planet again, not even think about it. But of course I do. How
can I not? I’m still a rebel. You cannot forget an experience, it’s stored in memory, even if out of
3D. They are worried that if I go there again (into the past) those existing then can rob me of
energy, so that I’m weak and damaged when I return to the present.
You may be thinking this is strange, but I have been in the past and the future. I know that all time
zones - past, present and future - co-exist now, in the moment. We live outside of time.
They work on me continuously during the conversation for over an hour until I feel fine. The
breakthrough is due to Vadim asking “Why is this taking so long, it should be easy”. I have a
© Maxwell Stirling, 10/2012!
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realisation and say “Tutti è facile per me! (everything is easy for me)”, and it is done. I feel fine
and my strength returns. We are all relieved, say our goodbyes, and they leave, warning me to rest
well for a good two months. I have not seen them again yet - I will in the future, I know it. ☺
Creator Knowledge
My take on this…
I say now that due to this Creator Knowledge I knew what was happening every time I had an
Out-of-Body or Near-Death Experience. This enabled me to decide during the process; “No I’m
going back”.
Sorry, I did not reach the “Pearly Gates”, nor heaven, nor meet any escorting angels, nor face any
other concepts. I was alone the whole time. Yes totally alone. Just me. I made all decisions and
direction changes without influence from “others”. I call this true Control.
Others have said there is nothing out there during the OBE. Believe me, they are totally incorrect.
Their perception must be severely limited to the extent that they do not believe in themselves,
perhaps thinking there is only fate, therefore becoming its victim. There is a vast Universe, within
and without. You may call it The All.
I was also able to heal myself efficiently and quickly. It’s all in the Consciousness. The doctors
were amazed that they could release me for a long-haul flight so soon after the operation. They
had in mind 3 to 4 weeks in a recovery home.
“Meanwhile, the patient is again symptom-free and so far mobilised, such that he can be released on this
day of our inpatient treatment.
“Inzwischen ist der Patient wieder insoweit beschwerdefrei und mobilisiert, so dass er am heutigen Tage
aus unsere stationären Behandlung entlassen werden kann.”
Because of much practice and familiarity, the methods came in image form without words, and
sometimes I had only to think of a method and it was done. Think about this. This is why we’re
pedantic about the need for frequent practice. You never know when it will re-pay you.
This Knowledge is a must-have for everyone
The life force is very strong in all of us. You’re not so sure? Just try holding your breath - how
long you can hold it? No matter how long, you cannot prevent the next breath from coming. And
this is only the body I’m speaking of. Think about spirit, soul, consciousness. How strong they
must be! Together, they create and constantly re-create (maintain) our body, and they will not let
it go easily. Only if it is beyond repair, or no longer serves the purpose of development will they
leave it behind.
Some people I know (who have this knowledge) are so brash they are saying I opened the doors of
Resurrection on this planet, which will make it easier for all humans in the future to do the same.
Hmmmm… I’m not so brash, I know I’m not the first to do this.
I recommend that no-one duplicates my experience.
Maxwell
© Maxwell Stirling, 10/2012!
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The hospital report…
Deutsch…!
(English)
Stirling Maxwell
Sehr geehrter Herr Kollege
Ihr Patient stand vom 31.08.2012 bis
13.09.2012 in unserer stationären
Behandlung.
Diagnose:
Großes, blutendes Ulcus im bereich des
Bulbus duodeni bei Z.n. Einnahme von
nichtsteroidalen Antirheumatika.
Z.n. Blutungsanämie mit Transfusion von
insgesamt 12 Erythrozytenkonzentraten und 2
FFP's
Z.n. postoperativer basaler Pneumonie mit
Pleuraergüssen beidseits
Therapie:
Notfallmäßige Laparotomie mit
Duodenotomie und Ulcus umstechung am
31.08.12 in Intubations vollnarkose
Postoperativ intensivcomplex medizinische
Behandlung, u.a. mit erneuter Bluttransfusion
und Helicobacter-pylori-Eradikationstherapie
Behandlung Und Verlauf:
Der o.g Patient war in den späten
Mittagstunden des 29.08.12 mit der
Symptomatik einer kreislauf und
Hämoglobinwirksamen oberen
gastrointestinalen Blutung vom Notarzt auf
unsere hiesiger internistische Abteilung
eingewiesen worden.
Anamnestisch
vorausgegangen war die Einnahme eines
nichtsteroidalen Antirheumatikums
(Ibuprofen) wegen Rückenschmerzen seit dem
23.08.12.
Endoskopisch konnte ein großes Ulcus im
Bereich des Bulbus duodeni mit stattgehabte
Blutung diagnostiziert werden. Ein
Gefäßstumpf im Bereich der Bulbus-spitze
war endoskopisch nur schwer zugängig, wurde
dennoch mit Suprarenin unterspritzt.
Begleitend war die Transfusion von insgesamt
erforderlich 7 Erythrozyten konzentraten und 2
FFP's unter intensivmedizinischer Betreuung
des Patienten erforderlich geworden.
Bezüglich der weiteren internistischen
Vorgeschichte verweisen wir auf den
Verlegungsbrief unserer internistischen
Kollegen.
In den Morgenstunden des 31.08.12 kam es
dann erneut zu einer Blutung aus besagtem
Ulcus duodeni, so das jetzt die Indikation zur
operativchirurgischen Sanierung gestellt
wurde. Unmittelbar nach Übernahme des
Patienten auf unsere hiesige
allgemeinechirurgische Abteilung Führten wir
die notfallmäßige Laparotomie durch. Bei der
Palpatorischen Exploration des Duodenums
war an der Hinterwand des Bulbus eine großen
Ulcus Nische zu tasten.
Nach Duodenotomie, bestätige sich der
Befund eines großen und tiefreichenden Ulcus
mit derbem Ulcus grund, und fraglich kleinem
gefäßstumpf im distalen Bereich, wobei zum
Operationszeitpunkt eine aktuelle Blutung
weder aus dem Ulcus grund noch dem
erheblich aufgeworfenen zirkulären Ulcus
rand bestand. Therapeutisch fürhten wir die
mehrfache Ulcus umstechung durch. Die
Duodenotomie wurde zweireihig verschlossen
und mit Fibrinkleber gesichert.
Der Patient konnte unmittelbar postoperativ
geplant, und problemlos extubiert werden, und
wurde sodann bis einschl. zum 09.09.12 auf
unserer hiesigen interdisziplinären
Intensivstation betreut. Postoperativ war die
Transfusion von nochmals 5 Erythrozyten
konzentraten notwendig, um den
Hämoglobinwert auf gewünschtem Niveau zu
stabilisieren.
Eine HelicobacterEradikationstherapie erfolgte ebenso wie eine
hochdosierte medikamentöse Thromboembolie-prophylaxe mit einem 1 x tgl. S.c. zu
applizierenden niedermolekularen Heparin.
Am 4. postoperativen Tage war der Patient
plötzlich schweißig, begleitet von einen
Troponin-T Anstieg. Die weiterführende
Diagnostik ergab jedoch weder Hinweise auf
eine Lungenembolie noch einem
Myokardinfarkt. Radiologische zeigte sich
jedoch eine basale Pneumonie beidseits mit
Pleuraergüssen. Therapeutisch kam hier ein
intensives Atemtraining unter
krankengymnastischer Anleitung zum Einsatz,
begleitet von der Medikation mit einem
Sekretolytikum.
Die postoperativ Mobilisation wurde von dem
Patienten gut toleriert. Postoperativ führten
wir zunächst eine vollständige parenterale
Ernährung über einem zentralvenösen Zugang
durch. Der Stuhlgang kam nach abführenden
Maßnahmen regelrecht in Gang. Der
nachfolgende Kostaufbau wurde ebenfalls gut
vertragen.
Die Analgesie erfolgte zunächst intravenös
und später peroral.
Die Wundheilung verlief bislang reizlos.
sämtliche Ableitungen sowie auch die
Hautklammern konnten termingerecht entfernt
werden.
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A m 1 0 . p o s t o p e r a t i v e n Ta g e f i e l
laborchemisch ein erneuter leichter Ansteig
der Leukozytenzahl und des CRP-Wertes auf,
j e d o c h o h n e Te m p e r a t u r e r h ö h u n g .
Nachfolgend kam es alsbald wieder zu einer
beginnenden Normalisierung der
laborchemischen Entzündungsparameter. Eine
weiterführende Diagnostik in Form einer
Röntgenkontrollaufnahme des Thorax und
auch einer Sonographie der Pleura beidseits
wurde von dem Patienten abgelehnt.
N a c h a b g e s c h l o s s e n e r H e l i c o b a c t e rEradikationstherapie haben wir die
hochdosiert Medikation mit dem
Protonenpumpeninhibitor zunächst
unverändert fortgesetzt.
Inzwischen ist der Patient wieder insoweit
beschwerdefrei und mobilisiert, so dass er am
heutigen Tage aus unsere stationären
Behandlung entlassen werden kann.
Letzte Medikation:
Pantaprozol
40 1-0-1
Acetylcystein Brause
1-0-0
Dalteparin Natrium
5000 iE 1x tgl. s.c.
Metamizol
bei Bedarf bis zu 4 x 40 Tropfen
Natrium picosulfat
bei Bedarf bis zu 20 Tropfen
Mit besten Dank für die Einweisung und
freundlichen kollegialen Grüßen
Dinkelsbühl,, 13.09.2012
Therapievorschlag:
Wir bitten um Fortführung der regelmäßigen
Wundkontrollen.
Ansonsten Fortsetzung des Kostaufbaus.
Momentan nimmt der Patient leichte Kost zu
sich.
Auf einem Regelmäßigen Stuhlgang sollte
unbedingt geachtet werden, ggf. Einsatz
milder Laxanzien, und zwar vorzugsweise von
Natrium Pico-Sulfat.
Die
Medikation
mit
der
Protonenpumpeninhibitor sollte zunächst noch
fortgesetzt, später in der Dosis reduziert
werden.
Bedarfsweise Fortführung der analgetischen
Medikation, wobei ein konventionelles
nichtsteroidales Antirheumatikum in
Anbetracht des o.g. Krankenheitsverlaufes
streng kontraindiziert ist; auch ansonsten
sollten sämtliche potenziell ulcerogene
Substanzen unbedingt vermieden werden.
Fortsetzung der Mobilisation sowie zunächst
noch der sekretolytischen Medikation.
Die
medikamentöse
Thromboembolieprophylaxe sollte für noch
eine Woche fortgesetzt werden, vorzugsweise
mit einem 1 x tgl. s.c. zu applizierenden
niedermolekularen Heparin unter
gelegentlicher Kontrolle der
Thrombozytenzahl.
© Maxwell Stirling, 10/2012!
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English…!
(Deutsch)
Stirling Maxwell
Dear Colleague
Your patient was from 31.08.2012 to
13.09.2012 in our residential treatment.
Diagnosis:
Large, bleeding ulcer in the area of the
duodenal bulb with Zn Taking NSAIDs.
Z.n. Blood loss anaemia with transfusion of a
total of 12 red blood cell concentrates and 2
FFP's
Z.n. postoperative basal pneumonia with
pleural effusions on both sides
Therapy:
Moderate emergency laparotomy with
duodenotomy and ulcer suturing on 31/08/12
in full anaesthesia intubation
Postoperative intensive complex medical
treatment, etc. with renewed blood transfusion
and Helicobacter pylori eradication therapy
Treatment And Course:
The above patient was admitted in the late
afternoon hours of 29.08.12 with symptoms of
circulatory and haemoglobin active upper
gastrointestinal bleeding by local emergency
on our internal department. Preceded by a
history of taking a non-steroidal antiinflammatory drug (Ibuprofen) because of
back pain since 23/08/12.
Endoscopy was a large ulcer in the duodenal
bulb diagnosed with previous history of
bleeding. A visible vessel in the bulb tip was
difficult to endoscopically access, yet was then
injected with epinephrine. Accompanying the
transfusion of red cell concentrates in total 7
required, and 2 FFP's was necessary under
intensive medical care of the patient.
Regarding the other internist history we refer
to the relocation of our internist colleagues
letter.
In the morning hours of 31/08/12, there was
again a bleeding from the said duodenal ulcer
so this has now made ​ ​ the indication for
surgical reconstruction surgery. Immediately
after acquisition of the patient at our local
general surgery department, we performed the
emergency laparotomy regular. During the
palpatory exploration of the duodenum a large
ulcer niche was palpable on the posterior wall
of the bulb.
After the duodenotomy, the findings confirm a
large and profound gastric ulcer with rough
ground and a questionable small vessel stump
© Maxwell Stirling, 10/2012!
in the distal region, which at the time of
surgery was not an actual bleeding from the
ulcer due to the still considerably raised
circular ulcer edge. Therapeutically we
controlled the multiple ulcer by suturing. The
duodenotomy was sealed double row and
secured with fibrin glue.
The patient was scheduled immediately after
surgery, and extubated without difficulty, and
was then supported for up until 09/09/12 in
our local multidisciplinary intensive care unit.
Postoperative transfusion of again 5
erythrocytes concentrates was necessary to
stabilise the haemoglobin level in the desired
level. Helicobacter eradication therapy was
like a high-dose drug thromboembolism
prophylaxis with 1 x daily Sc to be
administered low molecular weight heparin.
On the 4th day after surgery, the patient was
suddenly sweaty, accompanied by a rise in
troponin-T. Further diagnostic however
showed no evidence of pulmonary embolism
or myocardial infarction. Radiology showed
basal pneumonia with bilateral pleural
effusions. Therapeutically here an intensive
respiratory training came under guidance of a
physiotherapist to use, accompanied by the
medication with a secretolytic.
The postoperative mobilisation was well
tolerated by the patient. Postoperatively, we
performed first a total parenteral nutrition
through a central venous line. The bowels
were proper after laxative regimen was
underway. The subsequent food intake was
also well tolerated.
The analgesia was initially intravenous and
then oral.
Wound healing has progressed without
irritation. all derivatives as well as the skin
staples were removed on time.
On the 10th day after surgery, noticed by
laboratory tests a fresh slight rising in the
leukocyte count and CRP value, but without
increasing the temperature. Subsequently,
there was once again an early normalisation of
blood chemistry parameters of inflammation.
Further diagnostics in the form of an X-ray
radiograph of the chest and also an ultrasound
of the pleura on both sides was rejected by the
patient.
After completion of Helicobacter eradication
therapy, we continued the high dose of
medication with the proton pump inhibitor
initially unchanged.
Meanwhile, the patient is symptom-free and
again so far mobilised such that he can be
released on this day of our inpatient treatment.
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Leaving this existence… And returning… ❆
Recommended Treatment:
We ask you to continue the regular wound
checks.
Otherwise, continuing the diet structure.
Currently, the patient takes light snack.
A regular bowel movement should be ensured,
if necessary use a mild laxative, preferably of
Sodium pico sulphate.
The medication with the proton pump inhibitor
should be initially continued, later in reducing
dose.
If necessary, continue the analgesic medication
with a conventional NSAID in view of the
above Hospital awareness course is strictly
contraindicated, also likewise all potentially
ulcerogenic agents should be avoided.
Continuation of the mobilisation and initially
the secretolytic medication.
The pharmacological thromboembolic
prophylactic should be continued for a week,
to be administered preferably 1 x daily s.c.
with low molecular weight heparin with
occasional monitoring of the platelet count.
© Maxwell Stirling, 10/2012!
Last Medication:
Pantaprozol ...............................................40 1-0-1
Acetylcystein Spray .......................................1-0-0
Sodium Dalteparin ................5000 IU 1x daily s.c.
Metamizol .................as needed up to 4 x 40 drops
Sodium Picosulfate ......as needed up to 20 drops
With best thanks for the briefing and
Yours sincerely
Dinkelsbühl, 13/09/2012
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