DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Intraabdominal abscess secondary to perforated diverticulitis.
2. Rule out colon cancer.
POSTOPERATIVE DIAGNOSES:
1. Intraabdominal abscess secondary to perforated diverticulitis.
2. Rule out colon cancer.
OPERATION PERFORMED:
1. Drainage of intraabdominal abscess.
2. Segmental resection of sigmoid colon with proximal colostomy.
SURGEON: John Doe, MD
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: 200 mL.
SPECIMEN REMOVED: Segment of sigmoid colon.
OPERATIVE FINDINGS: The patient had an abscess in the mid lower left abdomen. It was walled off by a loop of small bowel and the omentum as well as a perforation in the sigmoid colon. The perforation showed some findings consistent with a perforated carcinoma with an apple core type of appearance. However, the final diagnosis will depend on the pathology report. There was considerable amount of pus and liquid stool in the abscess cavity. The small bowel was secondarily inflamed but was viable.
DESCRIPTION OF OPERATION: With the patient supine on the table, the abdomen was prepped with Betadine and draped in a sterile manner. A lower midline incision was made to enter the peritoneal cavity. Using blunt finger dissection, the omentum and small bowel were separated from the large bowel, and the abscess cavity was entered. The pus was aspirated. Cultures were taken for aerobes and anaerobes. The findings were as listed above. There was no evidence of gross metastatic disease.
The segmental dissection of the sigmoid colon was done leaving a 5 cm margin both proximally and distally. The large bowel was divided using a GIA stapling device both proximally and distally. The distal staple line was oversewn with 0 Prolene, which was dyed blue for easier identification in the future. The descending colon was mobilized by dividing the lateral peritoneal reflection, and the proximal cut end of the bowel was brought out through a separate colostomy incision in the left lower quadrant.
The peritoneal cavity was irrigated with at least 3 liters of saline. Prior to dissection of the bowel, the mesentery of the bowel was divided using a LigaSure device, and complete hemostasis was secured. The peritoneal cavity and fascia were now closed in a single layer with #1 PDS loop suture in a running locking fashion. The subcutaneous tissue was again thoroughly irrigated with normal saline, and the skin was approximated with skin staples.
The colostomy was matured by suturing the full thickness of the colon to the subcuticular tissue in a circumferential manner. There was no evidence of tension at the suture line, and there was good blood supply. A colostomy bag was applied, and a sterile dressing was applied. The patient withstood the operation well and left the table in satisfactory condition.
