ksb0211
Guest
ACK! I keep confusing myself with this one. Just hoping that I could get someone else's input. Thanks for checking it out!
PREOPERATIVE DIAGNOSIS
Mesenteric mass.
POSTOPERATIVE DIAGNOSIS
Mass of omentum and transverse mesocolon.
OPERATION PERFORMED
1. Laparoscopy with open laparotomy.
2. Pelvic exploration.
3. Lysis of adhesions.
4. Resection of mesenteric mass.
DESCRIPTION OF PROCEDURE
The patient was taken to the operating room after adequate general anesthesia. The patient as prepped with DuraPrep and draped sterilely. The initial incision was made in the infraumbilical region with a #15 blade and carried down through the subcutaneous tissues. The Veress needle was introduced. The abdomen was insufflated to 15 mmHg pressure with CO2. The 5 millimeters OptiView port was passed without difficulty. Circumferential view of the peritoneal cavity revealed no underlying bowel or vascular injuries. There is evidence of surgery in the pelvis. The 5 millimeter ports were placed in the right and then left rectus muscle. The sigmoid colon was adherent to what appeared to be a mass in the right pelvic wall. This was carefully dissected using laparoscopy. However, it became clear that the degree of adherence was something that should be addressed with open surgery. The lower midline incision was then made with a #15 blade and carried down through the subcutaneous tissues from the symphysis pubis cephalad. The peritoneal cavity was entered. It was apparent that there was a mass in the right pelvic area which was well-adherent to the sigmoid colon. Utilizing careful dissection I was able to free this from the sigmoid colon. Ultimately I was able to mobilize the tissue enough to realize that this was actually residual from her supracervical hysterectomy and that this was apparently normal residual cervix. The possibility that her pain was related to the adherence of the cuff to the sigmoid colon was entertained.
Further exploration was performed. The small bowel was run proximally from the ileocecal valve to the jejunum. No masses were identified. The posterior pelvis and abdomen was unremarkable. No significant adenopathy was appreciated. No mass was noted. No masses were appreciated in the mesentery of the small bowel. The omentum was then pulled down and above the level of the transverse colon a 2.3 centimeter mass was appreciated. It was bi-lobed the same as the mass noted on previous scans. It was significantly smaller. The lesion appeared to have a somewhat hemorrhagic appearance possibly lymph node or other. The mass was resected after passing clamps and ligating with 2-0 silk suture. Further exploration revealed no other significant lesions. This was passed off as specimen. The lap count was noted to be correct. The omentum was then tucked down into the pelvis posterior to the cuff of the supracervical hysterectomy. The midline incision was then closed with running double-stranded #1 PDS suture, 2-0 Vicryl was utilized in the subcutaneous tissue and clips applied to the skin. The estimated blood loss was perhaps 50 mL. The patient tolerated the procedure. Pathology is pending at this time.
BTW: Path came back as benign hemangioma.
PREOPERATIVE DIAGNOSIS
Mesenteric mass.
POSTOPERATIVE DIAGNOSIS
Mass of omentum and transverse mesocolon.
OPERATION PERFORMED
1. Laparoscopy with open laparotomy.
2. Pelvic exploration.
3. Lysis of adhesions.
4. Resection of mesenteric mass.
DESCRIPTION OF PROCEDURE
The patient was taken to the operating room after adequate general anesthesia. The patient as prepped with DuraPrep and draped sterilely. The initial incision was made in the infraumbilical region with a #15 blade and carried down through the subcutaneous tissues. The Veress needle was introduced. The abdomen was insufflated to 15 mmHg pressure with CO2. The 5 millimeters OptiView port was passed without difficulty. Circumferential view of the peritoneal cavity revealed no underlying bowel or vascular injuries. There is evidence of surgery in the pelvis. The 5 millimeter ports were placed in the right and then left rectus muscle. The sigmoid colon was adherent to what appeared to be a mass in the right pelvic wall. This was carefully dissected using laparoscopy. However, it became clear that the degree of adherence was something that should be addressed with open surgery. The lower midline incision was then made with a #15 blade and carried down through the subcutaneous tissues from the symphysis pubis cephalad. The peritoneal cavity was entered. It was apparent that there was a mass in the right pelvic area which was well-adherent to the sigmoid colon. Utilizing careful dissection I was able to free this from the sigmoid colon. Ultimately I was able to mobilize the tissue enough to realize that this was actually residual from her supracervical hysterectomy and that this was apparently normal residual cervix. The possibility that her pain was related to the adherence of the cuff to the sigmoid colon was entertained.
Further exploration was performed. The small bowel was run proximally from the ileocecal valve to the jejunum. No masses were identified. The posterior pelvis and abdomen was unremarkable. No significant adenopathy was appreciated. No mass was noted. No masses were appreciated in the mesentery of the small bowel. The omentum was then pulled down and above the level of the transverse colon a 2.3 centimeter mass was appreciated. It was bi-lobed the same as the mass noted on previous scans. It was significantly smaller. The lesion appeared to have a somewhat hemorrhagic appearance possibly lymph node or other. The mass was resected after passing clamps and ligating with 2-0 silk suture. Further exploration revealed no other significant lesions. This was passed off as specimen. The lap count was noted to be correct. The omentum was then tucked down into the pelvis posterior to the cuff of the supracervical hysterectomy. The midline incision was then closed with running double-stranded #1 PDS suture, 2-0 Vicryl was utilized in the subcutaneous tissue and clips applied to the skin. The estimated blood loss was perhaps 50 mL. The patient tolerated the procedure. Pathology is pending at this time.
BTW: Path came back as benign hemangioma.
