EbonyS123
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PREOPERATIVE DIAGNOSIS: Emphysema with blebs and bullae with
spontaneous pneumothorax.
POSTOPERATIVE DIAGNOSIS: Emphysema with blebs and bullae with
spontaneous pneumothorax.
OPERATION/PROCEDURES PERFORMED:
1. Right thoracotomy.
2. Wedge resection of multiple blebs and bullae.
3. Repair and resection of apical infected bullae.
SURGEON: Dr X
ASSISTANT: Dr. Y
ATTENDING SURGEON: Dr. O
ANESTHESIA: General endotracheal tube with a double-lumen tube.
ESTIMATED BLOOD LOSS: 100 mL.
FLUIDS: 2 liters.
DRAINS/TUBES: Foley catheter was left in place, as well as 2 chest
tubes in the right chest.
COMPLICATIONS: None.
POSTOPERATIVE CONDITION: Critical.
OPERATIVE FINDING: Infected, dense adhesions to the apical bleb with
evidence of recent infection, multiple bullae and blebs, wedge
resections, and emphysematous lungs. Specimens were sent to pathology.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room,
and prepped and draped in the standard fashion for a right thoracotomy.
A right thoracotomy, more anterolateral, was made entering into the
fifth interspace. Rib spreader was put into place, and the chest was
examined. There were dense adhesions to the apex with multiple large
bullae. Dissection was carried out extrapleural in that region. There
were blebs in the middle lobe along the lower edge, as well as some in
the lower lobe and the upper lobe throughout the lung, and clear
emphysematous changes throughout the lung as well. Water was placed
into the chest cavity, and 30 mmHg pressure was held. There were some
bubbles coming from what appeared to be the lower lobe. It was
difficult to locate the exact location. There was a minimal amount of
air leak from the apical bleb. Wedge resections were done of multiple
locations on the right lower lobe in the superior segment, the right
middle lobe along the lower edge, as well as the right upper lobe along
the edge of the anterior portion. The infected bleb that was in the
apex that was densely adhered to the chest wall was partially resected
and then sewn with a 2-0 Vicryl for repair of the apex of the lung. It
was too involved and too dense to be able to do a wedge resection of
that portion of the lung. Once this was complete, water was placed
into the chest cavity, once again putting 30 mmHg. There was a small
amount of air coming from one of the wedge resection stable lines,
otherwise relatively free from any air leaks. Two chest tubes were put
into place, 1 anterior and 1 posterior. Pericardial sutures were
placed around the ribs. Of note, the fifth rib was cracked in the
midline of the rib. The mechanical pleurodesis of the chest wall was
performed following by talc being placed within the chest cavity. The
chest was then closed, and ribs were reapproximated, followed by
closure of each of the muscle layers, serratus and latissimus; deep
dermal and skin layer was also performed. Dermabond was used to seal
the incision. The patient had 2 chest tubes prior to coming to the OR.
Those had been removed prior to starting the case, and an occlusive
dressing was placed over those 2 holes. The patient was transported to
the PACU where he is expected to recover and then be admitted to the
ICU.
spontaneous pneumothorax.
POSTOPERATIVE DIAGNOSIS: Emphysema with blebs and bullae with
spontaneous pneumothorax.
OPERATION/PROCEDURES PERFORMED:
1. Right thoracotomy.
2. Wedge resection of multiple blebs and bullae.
3. Repair and resection of apical infected bullae.
SURGEON: Dr X
ASSISTANT: Dr. Y
ATTENDING SURGEON: Dr. O
ANESTHESIA: General endotracheal tube with a double-lumen tube.
ESTIMATED BLOOD LOSS: 100 mL.
FLUIDS: 2 liters.
DRAINS/TUBES: Foley catheter was left in place, as well as 2 chest
tubes in the right chest.
COMPLICATIONS: None.
POSTOPERATIVE CONDITION: Critical.
OPERATIVE FINDING: Infected, dense adhesions to the apical bleb with
evidence of recent infection, multiple bullae and blebs, wedge
resections, and emphysematous lungs. Specimens were sent to pathology.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room,
and prepped and draped in the standard fashion for a right thoracotomy.
A right thoracotomy, more anterolateral, was made entering into the
fifth interspace. Rib spreader was put into place, and the chest was
examined. There were dense adhesions to the apex with multiple large
bullae. Dissection was carried out extrapleural in that region. There
were blebs in the middle lobe along the lower edge, as well as some in
the lower lobe and the upper lobe throughout the lung, and clear
emphysematous changes throughout the lung as well. Water was placed
into the chest cavity, and 30 mmHg pressure was held. There were some
bubbles coming from what appeared to be the lower lobe. It was
difficult to locate the exact location. There was a minimal amount of
air leak from the apical bleb. Wedge resections were done of multiple
locations on the right lower lobe in the superior segment, the right
middle lobe along the lower edge, as well as the right upper lobe along
the edge of the anterior portion. The infected bleb that was in the
apex that was densely adhered to the chest wall was partially resected
and then sewn with a 2-0 Vicryl for repair of the apex of the lung. It
was too involved and too dense to be able to do a wedge resection of
that portion of the lung. Once this was complete, water was placed
into the chest cavity, once again putting 30 mmHg. There was a small
amount of air coming from one of the wedge resection stable lines,
otherwise relatively free from any air leaks. Two chest tubes were put
into place, 1 anterior and 1 posterior. Pericardial sutures were
placed around the ribs. Of note, the fifth rib was cracked in the
midline of the rib. The mechanical pleurodesis of the chest wall was
performed following by talc being placed within the chest cavity. The
chest was then closed, and ribs were reapproximated, followed by
closure of each of the muscle layers, serratus and latissimus; deep
dermal and skin layer was also performed. Dermabond was used to seal
the incision. The patient had 2 chest tubes prior to coming to the OR.
Those had been removed prior to starting the case, and an occlusive
dressing was placed over those 2 holes. The patient was transported to
the PACU where he is expected to recover and then be admitted to the
ICU.
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