Wondering if anyone can help me with this surgery: THE PATIENT WAS BROUGHT INTO THE OPERATING ROOM AWAKE AND ALERT. SHE WAS PLACED ON THE OPERATING TABLE AND POSITIONED. SHE WAS PLACED UNDER GENERAL ENDOTRACHAEL ANESTHESIA. THE ABDOMEN WAS PREPARED AND DRAPED IN THE USUAL STERILE MANNER. A TIME OUT WAS TAKEN FOR IDENTIFICATION AND CONFIRMATION OF PROCEDURE. A MIDLINE INCISION WAS MADE FROM ABOVE THE UMBILICUS TO THE SUPRAPUBIC AREA AND EXTENDED DOWN TO THE MIDLINE FASCIA. THE LINEA ALBA WAS INCISED TO THE LENGTH OF THE SKIN WOUND AND THE PERITONEUM WAS ENTERED SHARPLY. THE ABDOMEN WAS EXPLORED AND MULTIPLE ABSCESSES WERE OPENED AND DRAINED. CULTURES WERE TAKEN BOTH AEROBIC AND ANAEROBIC. THE ADHESIONS WERE ALL TAKEN DOWN BLUNTLY AND THE FIBRINOUS EXUDATE WAS REMOVED. THE SMALL BOWEL WAS RUN FROM THE LIGAMENT OF TREITZ TO THE ILEOCECAL VALVE. THE APPENDIX AND CECUM WERE DELIVERED AND THE APPENDIX WAS VERY SWOLLEN. THE MESOAPPENDIX WAS TAKEN DOWN WITH THE LIGASURE. THE BASE OF THE APPENDIX WAS DIVIDED WITH THE ESCHELON STAPLING DEVICE BLUE STAPLES. THE APPENDIX WAS EXAMINED AND THERE WAS CONTAINED PUS IN THE MESOAPPENDIX WHICH WAS CULTURED SEPARATELY. THE ABSCESS IN THE MESOAPPENDIX WAS EXPLORED AND FOUND TO LEAD TO A CLEAR PERFORATION IN THE APPENDIX ITSELF. ATTENTION WAS GIVEN TO THE SIGMOID AND RECTOSIGMOID THAT WAS CAREFULLY EXAMINED. THERE WAS ONE THIN WALLED DIVERTICULUM THAT WAS REMOVED AT THE BASE ON THE SIGMOID WALL WITH THE ESCHELON DEVICE BLUE STAPLES. AS THERE WAS NO EVIDENCE OF A PERFORATION OF THE SIGMOID OR RECTOSIGMOID OR LEFT TRANSVERSE COLON OR SPLENIC FLEXURE, THERE NEEDED TO BE FURTHER CONFIRMATION. THE PATIENT WAS PLACED IN LITHOTOMY AND THE SIGMOID WAS SCOPED AND INFLATED WITH AIR WITH A GLASSMAN CLAMP ON THE MID SIGMOID. SIGMIFICANT PRESSURE WAS USED TO PUMP AIR INTO THE RECTOSIGMOID, AND THERE WAS NO AIR LEAK. AT THIS POINT, THE EXPLORATION WAS TERMINATED. THE PERITONEAL CAVITY WAS IRRIGATED WITH SALINE. THE SMALL BOWEL WAS PLACED INTO THE ABDOMEN. A 19 FRENCH BLAKE DRAIN WAS PLACED INTO THE PELVIS AND LED OUT THE LEFT LATERAL ABDOMINAL WALL. THE DRAIN WAS SUTURED IN PLACE WITH A #0 SILK. THE MIDLINE WAS CLOSED AT THE FASCIA WITH A RUNNING #0 LOOPED PDS. THE SUBCUTANEOUS TISSUE WAS IRRIGATED WITH SALINE AND THE SKIN WAS CLOSED WITH THE STAPLING DEVICE. PLASTIC WAS PLACED AT THE WOUND MARGINS AND SILVER SPONGE WAS PLACED OVER THE MIDLINE WOUND. THE PLASTIC WAS PLACED OVER THE SPONGE AND THE SPONGE WAS EXPOSED IN A TWO CENTIMETER AREA FOR THE WOUND VAC DISK. THE DISK WAS SECURED WITH THE WOUND VAC PLASTIC AND THE VAC WAS PLACED TO SUCTION. THE DRAIN SITE WAS COVERED WITH DRY STERILE GAUZE AND SECURED WITH THE WOUND VAC PLASTIC. THE PATIENT WAS AWAKENED, EXTUBATED AND RETURNED TO RECOVERY IN GOOD CONDITION. SHE TOLERATED THE PROCEDURE WELL. THERE WERE NO COMPLICATIONS. BLOOD LOSS ~ 200CC AND TOTAL FLUIDS WERE 1800CC, URINE OUTPUT WAS 150CC. FINAL SPONGE AND NEEDLE COUNTS WERE CORRECT.