T7-1B OPERATIVE REPORT, LAPAROTOMY

question 2

Essay

T7-1B OPERATIVE REPORT, LAPAROTOMY
OPERATIVE PROCEDURE: Laparotomy, adhesiolysis, release small bowel obstruction due to adhesions and internal hernia, and resection of small bowel to colonic fistula
HISTORY: This 47-year-old patient came in with a complete small bowel obstruction. There was a questionable lesion in her large bowel, but it was not obstructing. It is elected to take her to the operating room.
The patient came into the operating room at 2215 hours, and we did not start operating until 2350 hours. Please see anesthesia notes for the preoperative management of the patient during that time.
PROCEDURE: The patient was given a general anesthetic. We put her in stirrups, and she was prepped and draped in the supine fashion. We went through a previous midline incision. There were adhesions stuck right to the abdominal wall. We very carefully took these down. There were a lot of adhesions right against the abdominal wall, but we were able to take all of these down so that we could get at the small bowel. There was very dilated small bowel and then completely collapsed small bowel distally. When we had everything mobilized, we found that there was an internal hernia that was the main problem. There was a piece of small bowel stuck to her transverse colon. Bowel was running in between it. This was a complete obstruction. We very carefully dissected between the small bowel and the transverse colon, but it did not appear to be just adhesions. There was an actual connection that appeared to be a fistula. I used the TLC-55 stapler and came across the fistula going across the small bowel in a Heineke-Mikulicz fashion so that I did not impinge on the diameter of the small bowel. This gave an excellent resection of the fistula. We then identified that she indeed had had a right colon resection with a side-to-side anastomosis.
It appears that all the staples that I was seeing in the left lower quadrant were likely related to her stomach surgery that she had had in the past.
We found no other lesions. We carefully looked at all of the large bowel, and there was really nothing to find in any part of the large bowel. We paid particular attention to the area around the splenic flexure, and there was nothing to feel and there was certainly no distended large bowel. We then found we had an excellent hemostasis, and we had released the bowel obstruction. We then closed with 0 loop nylon. We closed the skin with staples. Telfa, Topper, and then gauze were applied. The patient tolerated this well and will go to ICU (intensive care unit).
T7-1B:
SERVICE CODE(S): ___________________________________________________
ICD-10-CM DX CODE(S): ______________________________________________

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Definitions:

Giuliano and Lorenzo de' Medici

Members of the prominent Medici family in Florence, Italy, who played significant roles in the politics, culture, and banking of the Renaissance period.

Pesaro Madonna

A Renaissance painting by Italian artist Titian, depicting the Madonna and Child with saints, known for its innovative composition and use of color.

High Renaissance

High Renaissance represents a period in the late 15th and early 16th centuries in Italy, characterized by significant advancements in art and architecture, with figures such as Leonardo da Vinci, Michelangelo, and Raphael.

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A geographical region of Italy that includes the administrative regions of Lazio, Marche, Tuscany, and Umbria.