sara0014
Contributor
Wondering if the take down of the right lower quadrant adhesions are just part of the exploratory?
PREOPERATIVE DIAGNOSIS: Small bowel obstruction.
POSTOPERATIVE DIAGNOSIS: Same, near complete. Mid ileum at site of previous appendectomy.
PROCEDURE: Exploratory laparotomy and take down of right lower quadrant adhesions.
ANESTHESIA:
INDICATIONS: The patient has a radiographic small bowel obstruction that failed to resolve overnight. Quite distended. Only prior procedure, abdominal, was a right paramedian incision for an appendectomy, many years ago. The patient agrees to exploration. We warned him that occasionally there is a malignant process or an inflammatory disease process such as Crohn disease causing his bowel obstruction, but the most likely preoperative diagnosis is adhesive disease.
He was taken to the operating room, 2 gm IV Mefoxin was given. He was intubated and Foley catheter was placed. Very little urine. He is dry. Will rehydrate him IV postoperatively. I trimmed his hair. He was prepped with Chloraprep. A midline incision to just above the umbilicus. He has tremendously dilated small bowel, all of which is easily extracted from the abdominal cavity. He doesn't have any ascites. His liver is normal. His peritoneal surfaces are normal. Small bowel mesentery surfaces are normal. His bowel obstruction is right at the midpoint of the anterior abdominal wall closure of his appendectomy. That was taken down, leaving the adhesion on the surface of the ileum, then his distal decompressed ileum was easily identified and brought up into the wound and his ileocecal valve and appendix extracted and visualized. We did not reflect any peritoneal surfaces. I placed one little tacking stitch of 3-0 Vicryl from one part of the adhesion to the other to close the anterior surface of the adhesion over his ileum. Serosa was not violated anywhere. Counts were correct twice.
We returned his small bowel to his abdominal cavity in an appropriate anatomic location with great care taken to not rotate his small mesentery. A third set of counts were correct. His wound was closed from above and below with running #1 Vicryl, skin with staples and no drain was placed.
EBL: Less than 5 mL.
COMPLICATIONS: None.
PREOPERATIVE DIAGNOSIS: Small bowel obstruction.
POSTOPERATIVE DIAGNOSIS: Same, near complete. Mid ileum at site of previous appendectomy.
PROCEDURE: Exploratory laparotomy and take down of right lower quadrant adhesions.
ANESTHESIA:
INDICATIONS: The patient has a radiographic small bowel obstruction that failed to resolve overnight. Quite distended. Only prior procedure, abdominal, was a right paramedian incision for an appendectomy, many years ago. The patient agrees to exploration. We warned him that occasionally there is a malignant process or an inflammatory disease process such as Crohn disease causing his bowel obstruction, but the most likely preoperative diagnosis is adhesive disease.
He was taken to the operating room, 2 gm IV Mefoxin was given. He was intubated and Foley catheter was placed. Very little urine. He is dry. Will rehydrate him IV postoperatively. I trimmed his hair. He was prepped with Chloraprep. A midline incision to just above the umbilicus. He has tremendously dilated small bowel, all of which is easily extracted from the abdominal cavity. He doesn't have any ascites. His liver is normal. His peritoneal surfaces are normal. Small bowel mesentery surfaces are normal. His bowel obstruction is right at the midpoint of the anterior abdominal wall closure of his appendectomy. That was taken down, leaving the adhesion on the surface of the ileum, then his distal decompressed ileum was easily identified and brought up into the wound and his ileocecal valve and appendix extracted and visualized. We did not reflect any peritoneal surfaces. I placed one little tacking stitch of 3-0 Vicryl from one part of the adhesion to the other to close the anterior surface of the adhesion over his ileum. Serosa was not violated anywhere. Counts were correct twice.
We returned his small bowel to his abdominal cavity in an appropriate anatomic location with great care taken to not rotate his small mesentery. A third set of counts were correct. His wound was closed from above and below with running #1 Vicryl, skin with staples and no drain was placed.
EBL: Less than 5 mL.
COMPLICATIONS: None.
