Appendectomy

By Gregory E. Jeansonne

34yo">

Appendectomy

By Gregory E. Jeansonne

34yo, Black Female, +300#, G2P2 via lower Ceasarian, Cholecystectomy, HTN, NIDDM.  

Complains of diffuse abdominal pain.  Treated medically for 3days with no improvement. 

1. Exploratory Laparoscopic procedure unsuccessful due to extensive adhesions from prior operations.

Laparoscope trocar inserted.  Nitrogen tube and Laparoscope visible in field.

2. Open Exploratory Laparotomy performed through Lower Midline incision.

Skin Incision     Electrical Cautery into Peritoneal Cavity

        Systematic Search of Abdominal Contents

3. Appendix identified as offending organ with subsequent removal.

Isolate Appendix by double clamping viable tissue at base.

Purse string suture appendix base.

Electrical Cautery to free appendix.

Ligate Mesoappendix vessels.

    Electrical Cautery to free Mesoappendix.

4. Clean and Close Wound.

    Inspect and Irrigate peritoneum for closure.

        Suture Peritoneum & Fascia.

    Staple Skin for primary closure.

6. Post Operative Complications:
2nd post operative day, Wound infection required debridement & second intention closure.
3rd post operative day, Fever spike following peritonitis treated with IV antibiotics.

7. Patient discharged on 7th post operative day with one week follow-up in Clinic.

8. Final Clinic visit at one month with no apparent long-term restrictions on activity related to operation.

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Revised: 05 August, 2002