Operative note

Question

OPERATING SURGEON: J. D. Smith, MD

ASSISTANT: W. G. Harris, MD

ANESTHESIA: General.

ANESTHESIOLOGIST: Scott Smith, MD

PREOPERATIVE DIAGNOSIS: Small-bowel obstruction.

POSTOPERATIVE DIAGNOSIS: Small-bowel obstruction secondary to intraabdominal adhesions.

OPERATION PERFORMED: Exploratory laparotomy, (1)________ of adhesions, and release of small-bowel obstruction.

OPERATIVE TECHNIQUE: The patient was prepped and draped in a routine manner under general anesthesia with endotracheal intubation. A (2)________ catheter was in place and draining clear urine. The patient was given 2 g of (3)________ antibiotic intravenously prior to incision.

A midline incision was made from the symphysis passing to the left of the umbilicus and continuing in the midline in the (4)________ area. The subcutaneous tissue was divided with sharp dissection. Electrocautery was used to provide subcutaneous hemostasis. The abdominal fascia was divided at the midline, and the posterior (5)________ and the peritoneum were entered with sharp (6)________. There were multiple dilated loops of large bowel and small bowel. However, the small-bowel dilatation was confined to the proximal and midjejunum. Examination of the upper abdomen revealed the liver to be of normal size and consistency, the gallbladder also normal. There was no evidence of hepatic (7)________. The (8)________ spaces were negative to palpation and visualization. There was no evidence of neoplasm or obstruction in the large intestine.

There was an adhesive band involving the midjejunum in the left lower quadrant from previous exploratory surgery. Using (9)________scissors, with blunt and sharp dissection, a 10 cm to 15 cm loop of midjejunum was freed up, resulting in release of the adhesive obstruction. The remainder of the small bowel was run throughout its length, and no further obstructions were seen. The (10)________ were placed in their normal position and covered with the fatty omentum. When instrument, sponge, and pack count were correct and (11)________ was satisfactory, the peritoneum was closed with a running 2-0 chromic lock suture. The anterior and posterior fascia were approximated with interrupted with 0 (12)________ suture. The subcutaneous tissue space was irrigated with saline solution and sponged dry. The skin was closed with interrupted staples and an Adaptic 4 × 4 dressing applied. Blood loss estimated at approximately 150 mL.

The patient tolerated the procedure well and left the operating room in good condition.

Answer 1

1. lysis
2. Foley
3. Cefotan
4. epigastric
5. fascia
6. dissection
7. neoplasm
8. retroperitoneal
9. Metzenbaum
10. viscera
11. hemostasis
12. Vicryl