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PREOPERATIVE DIAGNOSES:
1. Complex left ovarian mass.
2. Pelvic pain.
POSTOPERATIVE DIAGNOSES:
1. Complex left ovarian mass.
2. Extensive pelvic adhesive disease.
PROCEDURE:
1. Exploratory laparotomy.
2. Bilateral salpingo-oophorectomy.
3. Enterolysis.
4. Repair of large and small bowel seromuscular injuries.
ANESTHESIA: General endotracheal.
ESTIMATED BLOOD LOSS: 300 cc.
COMPLICATIONS: None.
FINDINGS: Extensive pelvic adhesions between loops of small bowel and large bowel
throughout the pelvis and abdomen. The patient had an approximately 7-8 cm, left
ovarian mass adhered down to the left pelvic sidewall and adhered to numerous loops
of bowel. The right ovary likewise was adhered deep in the pelvis and adhered to
the right pelvic sidewall and to overlying loops of bowel. The uterus and cervix
were surgically absent. There was no free fluid or ascites. There was no visible
evidence of endometriosis.
TECHNIQUE: The patient was taken tot he Operating Room and placed on the table in
the supine position. She was placed under general endotracheal anesthesia. A
Foley catheter was inserted by the nurse. Her abdomen, perineum and vagina were
prepped with Betadine and she was draped in the usual sterile fashion. A
Pfannenstiel skin incision was made which removed her previous keloided
Pfannenstiel scar. This was carried down through the subcutaneous tissue, fascia
and peritoneum. Numerous adhesions were encountered between the anterior abdominal
wall and the underlying bowel. Theses adhesions were taken down using Metzenbaum
scissors and the Bovie device. Extensive enterolysis was then performed, taking
down adhesions between loops of bowel to investigate the left complex mass. After
about 40 minutes of enterolysis, an intraoperative consult was made to Dr. Megan
Indermaur, who performed as co-surgeon for the case. She scrubbed in and placed a
Bookwalter retractor and lap sponges were placed to retract the bowel superiorly.
Further enterolysis was performed with repair of large and small bowel seromuscular
injuries as needed as the procedure ensued. The left complex mass was then
identified and carefully freed up from the left pelvic sidewall, taking care to
follow the left ureter throughout. The mass was incidentally ruptured and clear
yellow fluid was expressed. The cyst was excised from the left pelvic sidewall and
from the bowel, and was sent to Pathology. Attention was then turned to the right
ovary, which was buried underneath numerous loops of bowel. After enterolysis was
performed in that area, the right ovary was identified and was freed up from its
adhesed location along the right pelvic sidewall and the right ureter. The right
ureter was followed and found to be peristalsing normally throughout. After the
right ovary was removed, it was sent to Pathology. The pelvis was copiously
irrigated with warm saline until clear. All loops of bowel were checked and all
repair sites were inspected as well. The bladder was checked and appeared to be
intact. She was making clear urine. Bleeders were made hemostatic using the
Bovie device. Gelfoam soaked with thrombin was placed along the raw edges in the
pelvis. The peritoneal layer was then closed using a running stitch of 2-0 Vicryl.
The fascia was closed using 2 separate running stitches of 0-Vicryl, each
individually tied in the midline. The subcutaneous tissue was irrigated, inspected
and found to be hemostatic. This layer was reapproximated using running 3-0
Vicryl. The skin was closed using a stapling device. Bandages were applied. All
sponge, lap and needle counts were reported as correct. She was taken to the
Recovery Room in stable condition by the anesthesia team.
1. Complex left ovarian mass.
2. Pelvic pain.
POSTOPERATIVE DIAGNOSES:
1. Complex left ovarian mass.
2. Extensive pelvic adhesive disease.
PROCEDURE:
1. Exploratory laparotomy.
2. Bilateral salpingo-oophorectomy.
3. Enterolysis.
4. Repair of large and small bowel seromuscular injuries.
ANESTHESIA: General endotracheal.
ESTIMATED BLOOD LOSS: 300 cc.
COMPLICATIONS: None.
FINDINGS: Extensive pelvic adhesions between loops of small bowel and large bowel
throughout the pelvis and abdomen. The patient had an approximately 7-8 cm, left
ovarian mass adhered down to the left pelvic sidewall and adhered to numerous loops
of bowel. The right ovary likewise was adhered deep in the pelvis and adhered to
the right pelvic sidewall and to overlying loops of bowel. The uterus and cervix
were surgically absent. There was no free fluid or ascites. There was no visible
evidence of endometriosis.
TECHNIQUE: The patient was taken tot he Operating Room and placed on the table in
the supine position. She was placed under general endotracheal anesthesia. A
Foley catheter was inserted by the nurse. Her abdomen, perineum and vagina were
prepped with Betadine and she was draped in the usual sterile fashion. A
Pfannenstiel skin incision was made which removed her previous keloided
Pfannenstiel scar. This was carried down through the subcutaneous tissue, fascia
and peritoneum. Numerous adhesions were encountered between the anterior abdominal
wall and the underlying bowel. Theses adhesions were taken down using Metzenbaum
scissors and the Bovie device. Extensive enterolysis was then performed, taking
down adhesions between loops of bowel to investigate the left complex mass. After
about 40 minutes of enterolysis, an intraoperative consult was made to Dr. Megan
Indermaur, who performed as co-surgeon for the case. She scrubbed in and placed a
Bookwalter retractor and lap sponges were placed to retract the bowel superiorly.
Further enterolysis was performed with repair of large and small bowel seromuscular
injuries as needed as the procedure ensued. The left complex mass was then
identified and carefully freed up from the left pelvic sidewall, taking care to
follow the left ureter throughout. The mass was incidentally ruptured and clear
yellow fluid was expressed. The cyst was excised from the left pelvic sidewall and
from the bowel, and was sent to Pathology. Attention was then turned to the right
ovary, which was buried underneath numerous loops of bowel. After enterolysis was
performed in that area, the right ovary was identified and was freed up from its
adhesed location along the right pelvic sidewall and the right ureter. The right
ureter was followed and found to be peristalsing normally throughout. After the
right ovary was removed, it was sent to Pathology. The pelvis was copiously
irrigated with warm saline until clear. All loops of bowel were checked and all
repair sites were inspected as well. The bladder was checked and appeared to be
intact. She was making clear urine. Bleeders were made hemostatic using the
Bovie device. Gelfoam soaked with thrombin was placed along the raw edges in the
pelvis. The peritoneal layer was then closed using a running stitch of 2-0 Vicryl.
The fascia was closed using 2 separate running stitches of 0-Vicryl, each
individually tied in the midline. The subcutaneous tissue was irrigated, inspected
and found to be hemostatic. This layer was reapproximated using running 3-0
Vicryl. The skin was closed using a stapling device. Bandages were applied. All
sponge, lap and needle counts were reported as correct. She was taken to the
Recovery Room in stable condition by the anesthesia team.