Exploratory laparotomy
PREOPERATIVE DIAGNOSIS
Perforated viscus.
POSTOPERATIVE DIAGNOSIS
Perforated pre-pyloric ulcer.
PROCEDURE
Exploratory laparotomy with omental patch repair of perforated pre-pyloric ulcer.
ANESTHESIA
General.
ESTIMATED BLOOD LOSS
3 mL.
COMPLICATIONS
None.
FINDINGS
Perforated pre-pyloric ulcer measuring approximately 1.5-2.0 cm in diameter with no other intra-abdominal abnormalities and the previous colorectal anastomosis was intact.
OPERATIVE NOTE
The patient was brought to the operative suite, placed supine on operating table. After adequate general anesthesia had been achieved, the abdomen was prepped and draped in usual sterile fashion. Then, the patient's previous abdominal incision was opened and the previously placed PDS sutures were removed. The patient's mesh from her recent hernia repair was removed and then upon entering the abdominal cavity there was a large amount of fluid noted in the upper abdomen, which was purulent. This was then swabbed for culture and sensitivity. Then, the fluid in the upper abdomen was removed by suction irrigation and in the upper abdomen in the region of the stomach, there was noted to be a pre-pyloric ulcer. A large pre-pyloric ulcer measuring approximately 1.5-2.0 cm in diameter. This was obvious source of the patient's perforation and was consistent with the preoperative CT scan findings, so this required omental patch. So using 3-0 Ethibond suture in an interrupted fashion. The perforation was closed and a segment of the omentum was secured over the closure using 3-0 Ethibond suture as an omental patch. Then, the upper abdomen was copiously irrigated with normal saline approximately 7 L. Until the upper abdomen was clear and free from any purulent fluid. Then, the rest of the abdomen was explored and there were no other abnormalities identified. The small bowel was normal and the patient's previous colorectal anastomosis was examined and noted to be intact with no evidence of leak. The lower abdomen and pelvis was then further irrigated with normal saline and then a 10-French JP drain was placed in the upper abdomen along the patient's omental patch repair. Then, the fascia was closed with #1 PDS suture in a running fashion and the wound was packed open with sterile gauze. Sterile dressings were applied. The needle, sponge, and instrument counts were correct at the end of the case and the patient was then transferred to the intensive care unit in stable, but guarded condition.
Perforated viscus.
POSTOPERATIVE DIAGNOSIS
Perforated pre-pyloric ulcer.
PROCEDURE
Exploratory laparotomy with omental patch repair of perforated pre-pyloric ulcer.
ANESTHESIA
General.
ESTIMATED BLOOD LOSS
3 mL.
COMPLICATIONS
None.
FINDINGS
Perforated pre-pyloric ulcer measuring approximately 1.5-2.0 cm in diameter with no other intra-abdominal abnormalities and the previous colorectal anastomosis was intact.
OPERATIVE NOTE
The patient was brought to the operative suite, placed supine on operating table. After adequate general anesthesia had been achieved, the abdomen was prepped and draped in usual sterile fashion. Then, the patient's previous abdominal incision was opened and the previously placed PDS sutures were removed. The patient's mesh from her recent hernia repair was removed and then upon entering the abdominal cavity there was a large amount of fluid noted in the upper abdomen, which was purulent. This was then swabbed for culture and sensitivity. Then, the fluid in the upper abdomen was removed by suction irrigation and in the upper abdomen in the region of the stomach, there was noted to be a pre-pyloric ulcer. A large pre-pyloric ulcer measuring approximately 1.5-2.0 cm in diameter. This was obvious source of the patient's perforation and was consistent with the preoperative CT scan findings, so this required omental patch. So using 3-0 Ethibond suture in an interrupted fashion. The perforation was closed and a segment of the omentum was secured over the closure using 3-0 Ethibond suture as an omental patch. Then, the upper abdomen was copiously irrigated with normal saline approximately 7 L. Until the upper abdomen was clear and free from any purulent fluid. Then, the rest of the abdomen was explored and there were no other abnormalities identified. The small bowel was normal and the patient's previous colorectal anastomosis was examined and noted to be intact with no evidence of leak. The lower abdomen and pelvis was then further irrigated with normal saline and then a 10-French JP drain was placed in the upper abdomen along the patient's omental patch repair. Then, the fascia was closed with #1 PDS suture in a running fashion and the wound was packed open with sterile gauze. Sterile dressings were applied. The needle, sponge, and instrument counts were correct at the end of the case and the patient was then transferred to the intensive care unit in stable, but guarded condition.
Comments
Post a Comment