Digestive and Urinary Systems Case Studies Operative Report Preoperative Diagnosis: Acute cholecystitis Postoperative Diagnosis: Acute cholecystitis with partially gangrenous gallbladder Operation: Laparoscopic converted to open cholecystectomy Anesthesia: General Estimated Blood Loss: 150 cc Urine Output: 100 cc Intravenous Fluids: 2500 cc of lactated Ringer's Complications: None Findings: A partially gangrenous but mostly inflamed gallbladder with up to 1 cm thick gallbladder wall and multiple (greater than 50–100) small stones, each measuring approximately 2–4 mm Description of Procedure: The patient was brought into the OR and placed in the supine position on the operating table. After successful endotracheal intubation, general anesthesia was safely achieved. Her entire abdomen was prepped with Betadine and draped in a sterile fashion. A 2.5-cm supraumbilical transverse incision was made for placement of a Verres needle to achieve pneumoperitoneum and the intra-abdominal cavity was insufflated with CO2 with difficulty. After the fascia on each side of the midline was secured with stay sutures, a knife blade was used to open the fascia and the 10-mm trocar was placed at this site. Upon insertion of the laparoscopic camera, no bowel injury was detected. A 10-mm trocar was then placed in the epigastric position at the midline. Two 5-mm ports were placed in the right upper quadrant, one around the nipple line just below the costal margin and the other around the anterior axillary line again below the costal margin. Through one of the 5- mm ports, an endoscopic needle attached to a 60-cc syringe was inserted in order to
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- Winter '17
- Williams, Kristy H.