deliciatraylor
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Can someone please help me with this?
PREOP DX: Penetrating wound to the abdomen with retained foreign body.
POSTOPERATIVE DIAGNOSES:
1. Penetrating wound to the abdomen with retained foreign body.
2. Contusion of anti-mesenteric fat of transverse colon
PROCEDURES:
1. Trauma laparotomy.
2. Removal of foreign body in anterior abdominal wall
3. Repair of posterior fascial defect from penetrating wound.
ANESTHESIA: General per endotracheal tube.
Hx: Patient is a 29-year-old male, who was at work in a metal scrap shop this evening,
where he was working with metal equipment. While attempting to hammer a metal pin into
a hole in a piece of equipment, a portion of the pin broke off and at a high speed went into
his abdomen. He had significant abdominal pain when this occurred. In
the trauma bay, he had tenderness in the left upper quadrant with an
approximately 3 mm wound in the mid aspect of the left upper quadrant. FAST
was negative. He was hemodynamically stable. He underwent chest/abd/pelvic
CT scan to more precisely find the location of this foreign body and rule out
fragments in light of concern of the high speed and potential fragmentation.
On CT scan, there appeared to be a single piece of metallic foreign body,
which appeared to have violated the peritoneum and was close to the bowel.
There was no evidence of any free air and no evidence of any hematoma near the
bowel to suggest bowel injury; however, in light of the proximity of the bowel to the
metallic fragmen and the high speed by history of this projectile, I was concerned that
there could have been contusion or involvement of the bowel that was not identifiable on CT scan.
Thus, it was recommended that the patient to be taken to the operating room
for trauma laparotomy for evaluation and possible resection and/or repair
pending the intraoperative findings. Patient agreed to the procedure and was thus
taken to the operating room.
Full documentation of the proposed procedure as well as the alternatives and the
risks were thoroughly discussed with the patient and outlined in the patient's chart.
DESCRIPTION OF THE PROCEDURE: Patient was taken to the operating room, placed
supine on the operating room table. Endotracheal intubation was performed by
the Anesthesia Service.
Prior to induction of anesthesia, the patient received cefoxitin in 2 g IV.
The abdomen was prepped with ChloraPrep then sterilely draped in the usual
fashion. A time-out was performed and all agreed.
A midline incision was made in the upper abdomen staying above the umbilicus
in light of the location of the foreign body on CT scan and location of probable
penetration of the abdominal cavity appeared to be approximately 5 cm
above the umbilicus and approximately 4 cm to the left of the midline on CT. Thus the
Incision was centered around this point.
The incision was continued on down through subcutaneous tissue. Fascia was
identified and was opened the length of the incision being careful of any
underlying abdominal contents.
Upon entering the abdomen, what felt like the foreign body could be
palpated, in the peritoneal aspect of the anterior abdominal wall, and
was located close to the umbilicus approximately 3 cm superior to the umbilicus and
approximately 2 cm lateral to the midline. In light of the location of the
foreign body appearing to be closure to the umbilicus than identified on CT
scan, the incision, was extended around the left of the
umbilicus to give us adequate exposure of the organs lying in the area adjacent to the
foreign body. This allowed us to identify the metallic foreign body and there was violation of the
peritoneum. The foreign body was easily grasped with a Kocher clamp and
extracted. There was no evidence of acute bleeding. The transverse colon
was near this area of penetration. There did not appear to be any injury to
the transverse colon; however, there was an apron of fatty tissue off the antimesenteric
border of the transverse colon underlying the area of the foreign body penetration and it
did have several areas of contusion without any acute bleeding or
significant hematoma.
Hand-held retractors were placed and the transverse colon was inspected in its entirety
from the hepatic flexure over towards the distal transverse colon. Again, no
contusions were noted in the transverse colon or the transverse mesocolon. The small bowel
was ran from the ligament of Treitz down to the ileocecal valve with careful inspection of
it throughout its entirety and there was no evidence of any contusions or
hematomas. No evidence of any contusion or hematomas of the small bowel
mesentery.
The small bowel was then placed back int its anatomical position. The abdomen
was irrigated with approximately 1 L of warm saline.
The defect in the posterior fascia was reapproximated using 2 interrupted
0-PDS sutures in a figure-of-eight fashion. The defect which was closed was
approximately 1 cm.
The fascia of the midline incision was closed using a running looped #1
PDS starting from each end and meeting in the middle and tying them together. There
was a small umbilical hernia, which was incorporated into the incision and closed with the
fascial closure. Subcutaneous tissue was irrigated with saline. Skin was
reapproximated with staples.
The small puncture wound in the mid-aspect of the left upper quadrant was irrigated with
saline. It was left open in light of the dirty wound.
Patient was extubated in the operating room and transferred to the
recovery room.
All sponge and needle counts were correct.
SPECIMENS: Foreign body from abdominal wall for gross
PREOP DX: Penetrating wound to the abdomen with retained foreign body.
POSTOPERATIVE DIAGNOSES:
1. Penetrating wound to the abdomen with retained foreign body.
2. Contusion of anti-mesenteric fat of transverse colon
PROCEDURES:
1. Trauma laparotomy.
2. Removal of foreign body in anterior abdominal wall
3. Repair of posterior fascial defect from penetrating wound.
ANESTHESIA: General per endotracheal tube.
Hx: Patient is a 29-year-old male, who was at work in a metal scrap shop this evening,
where he was working with metal equipment. While attempting to hammer a metal pin into
a hole in a piece of equipment, a portion of the pin broke off and at a high speed went into
his abdomen. He had significant abdominal pain when this occurred. In
the trauma bay, he had tenderness in the left upper quadrant with an
approximately 3 mm wound in the mid aspect of the left upper quadrant. FAST
was negative. He was hemodynamically stable. He underwent chest/abd/pelvic
CT scan to more precisely find the location of this foreign body and rule out
fragments in light of concern of the high speed and potential fragmentation.
On CT scan, there appeared to be a single piece of metallic foreign body,
which appeared to have violated the peritoneum and was close to the bowel.
There was no evidence of any free air and no evidence of any hematoma near the
bowel to suggest bowel injury; however, in light of the proximity of the bowel to the
metallic fragmen and the high speed by history of this projectile, I was concerned that
there could have been contusion or involvement of the bowel that was not identifiable on CT scan.
Thus, it was recommended that the patient to be taken to the operating room
for trauma laparotomy for evaluation and possible resection and/or repair
pending the intraoperative findings. Patient agreed to the procedure and was thus
taken to the operating room.
Full documentation of the proposed procedure as well as the alternatives and the
risks were thoroughly discussed with the patient and outlined in the patient's chart.
DESCRIPTION OF THE PROCEDURE: Patient was taken to the operating room, placed
supine on the operating room table. Endotracheal intubation was performed by
the Anesthesia Service.
Prior to induction of anesthesia, the patient received cefoxitin in 2 g IV.
The abdomen was prepped with ChloraPrep then sterilely draped in the usual
fashion. A time-out was performed and all agreed.
A midline incision was made in the upper abdomen staying above the umbilicus
in light of the location of the foreign body on CT scan and location of probable
penetration of the abdominal cavity appeared to be approximately 5 cm
above the umbilicus and approximately 4 cm to the left of the midline on CT. Thus the
Incision was centered around this point.
The incision was continued on down through subcutaneous tissue. Fascia was
identified and was opened the length of the incision being careful of any
underlying abdominal contents.
Upon entering the abdomen, what felt like the foreign body could be
palpated, in the peritoneal aspect of the anterior abdominal wall, and
was located close to the umbilicus approximately 3 cm superior to the umbilicus and
approximately 2 cm lateral to the midline. In light of the location of the
foreign body appearing to be closure to the umbilicus than identified on CT
scan, the incision, was extended around the left of the
umbilicus to give us adequate exposure of the organs lying in the area adjacent to the
foreign body. This allowed us to identify the metallic foreign body and there was violation of the
peritoneum. The foreign body was easily grasped with a Kocher clamp and
extracted. There was no evidence of acute bleeding. The transverse colon
was near this area of penetration. There did not appear to be any injury to
the transverse colon; however, there was an apron of fatty tissue off the antimesenteric
border of the transverse colon underlying the area of the foreign body penetration and it
did have several areas of contusion without any acute bleeding or
significant hematoma.
Hand-held retractors were placed and the transverse colon was inspected in its entirety
from the hepatic flexure over towards the distal transverse colon. Again, no
contusions were noted in the transverse colon or the transverse mesocolon. The small bowel
was ran from the ligament of Treitz down to the ileocecal valve with careful inspection of
it throughout its entirety and there was no evidence of any contusions or
hematomas. No evidence of any contusion or hematomas of the small bowel
mesentery.
The small bowel was then placed back int its anatomical position. The abdomen
was irrigated with approximately 1 L of warm saline.
The defect in the posterior fascia was reapproximated using 2 interrupted
0-PDS sutures in a figure-of-eight fashion. The defect which was closed was
approximately 1 cm.
The fascia of the midline incision was closed using a running looped #1
PDS starting from each end and meeting in the middle and tying them together. There
was a small umbilical hernia, which was incorporated into the incision and closed with the
fascial closure. Subcutaneous tissue was irrigated with saline. Skin was
reapproximated with staples.
The small puncture wound in the mid-aspect of the left upper quadrant was irrigated with
saline. It was left open in light of the dirty wound.
Patient was extubated in the operating room and transferred to the
recovery room.
All sponge and needle counts were correct.
SPECIMENS: Foreign body from abdominal wall for gross