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.

Mvc-001f.jpg (36382 bytes)Laparoscope trocar inserted.  Nitrogen tube and Laparoscope visible in field.

2. Open Exploratory Laparotomy performed through Lower Midline incision.

Mvc-002f.jpg (34720 bytes) Skin Incision     Mvc-004f.jpg (44138 bytes)Electrical Cautery into Peritoneal Cavity

Mvc-009f.jpg (46024 bytes)     Mvc-010f.jpg (56610 bytes)    Mvc-018f.jpg (47863 bytes)Systematic Search of Abdominal Contents

3. Appendix identified as offending organ with subsequent removal.

Mvc-020f.jpg (47055 bytes)Isolate Appendix by double clamping viable tissue at base.

Mvc-023f.jpg (41095 bytes)Purse string suture appendix base.

Mvc-022f.jpg (56902 bytes)Electrical Cautery to free appendix.

Mvc-025f.jpg (50698 bytes)Ligate Mesoappendix vessels.

Mvc-026f.jpg (43919 bytes)     Mvc-027f.jpg (31481 bytes)Electrical Cautery to free Mesoappendix.

4. Clean and Close Wound.

Mvc-028f.jpg (46089 bytes)     Mvc-001f.jpg (51216 bytes)Inspect and Irrigate peritoneum for closure.

Mvc-004f.jpg (45448 bytes)     Mvc-008f.jpg (45532 bytes)    Suture Peritoneum & Fascia.

Mvc-013f.jpg (41190 bytes)     Mvc-015f.jpg (40208 bytes)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