deliciatraylor
Contributor
Can someone please help me with this Op procedure. Any advice is greatly appreciated.
PREOP DX: Damage control laparotomy with ABThera VAC placement.
POSTOP DX: Hemorrhage, left upper quadrant, and damage control laparotomy
with ABThera VAC placement.
PROC: Exploratory laparotomy evacuation of left upper quadrant clot, right
colon mobilization and small bowel lysis of adhesions with creation of loop
diverting ileostomy, packing of the left upper quadrant, and ABThera VAC
replacement.
ESTIMATED BLOOD LOSS: 500 mL.
ANESTHESIA: General. The patient already has a tracheostomy.
DRAINS: Left upper quadrant and pelvis 19-French Blake drains.
DESCRIPTION OF PROCEDURE: The patient was brought to the operative suite and
placed in a supine position. After the appropriate induction of general
anesthesia, universal time-out consent procedure was held and all were in
agreement. The previous ABThera VAC was removed. The patient had been
prepped and draped in a sterile fashion after the VAC was removed. Entrance
into the abdominal cavity showed feculent fluid. The abdomen was washed out
with 6 L of fluid. Attention was then drawn to the right lower quadrant,
where the cecum and proximal ascending colon were mobilized, and then the
small bowel was followed proximally from the ileocecal valve with lysis of
adhesions for approximately 45 minutes. This freed the ileum to a point where
a loop ileostomy could be created. Attention was drawn to the left upper
quadrant, where significant clot was present. This was evacuated. A
Bookwalter retractor was utilized to visualize both the renal bed and the
splenic bed. No discrete bleeding area could be identified. Avitene,
thrombin spray, Gelfoam, and Surgicel were all placed in the left
upper quadrant and laparotomy packs were placed. The loop ileostomy was
created through a right lower quadrant incision and secured over an ostomy
bolster. The abdomen was washed out. Two drains were placed, 1 in the left
upper quadrant and 1 in the pelvis. The fascia was primarily closed
approximately 33% of the way and then the ABThera VAC was replaced into the
abdominal cavity and secured. The patient was transported to the ICU in
stable condition, requiring some Levophed. He received 3 units of packed
cells intraoperatively.
PREOP DX: Damage control laparotomy with ABThera VAC placement.
POSTOP DX: Hemorrhage, left upper quadrant, and damage control laparotomy
with ABThera VAC placement.
PROC: Exploratory laparotomy evacuation of left upper quadrant clot, right
colon mobilization and small bowel lysis of adhesions with creation of loop
diverting ileostomy, packing of the left upper quadrant, and ABThera VAC
replacement.
ESTIMATED BLOOD LOSS: 500 mL.
ANESTHESIA: General. The patient already has a tracheostomy.
DRAINS: Left upper quadrant and pelvis 19-French Blake drains.
DESCRIPTION OF PROCEDURE: The patient was brought to the operative suite and
placed in a supine position. After the appropriate induction of general
anesthesia, universal time-out consent procedure was held and all were in
agreement. The previous ABThera VAC was removed. The patient had been
prepped and draped in a sterile fashion after the VAC was removed. Entrance
into the abdominal cavity showed feculent fluid. The abdomen was washed out
with 6 L of fluid. Attention was then drawn to the right lower quadrant,
where the cecum and proximal ascending colon were mobilized, and then the
small bowel was followed proximally from the ileocecal valve with lysis of
adhesions for approximately 45 minutes. This freed the ileum to a point where
a loop ileostomy could be created. Attention was drawn to the left upper
quadrant, where significant clot was present. This was evacuated. A
Bookwalter retractor was utilized to visualize both the renal bed and the
splenic bed. No discrete bleeding area could be identified. Avitene,
thrombin spray, Gelfoam, and Surgicel were all placed in the left
upper quadrant and laparotomy packs were placed. The loop ileostomy was
created through a right lower quadrant incision and secured over an ostomy
bolster. The abdomen was washed out. Two drains were placed, 1 in the left
upper quadrant and 1 in the pelvis. The fascia was primarily closed
approximately 33% of the way and then the ABThera VAC was replaced into the
abdominal cavity and secured. The patient was transported to the ICU in
stable condition, requiring some Levophed. He received 3 units of packed
cells intraoperatively.