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DATE OF PROCEDURE: October 2017
PREOPERATIVE DIAGNOSIS: Acute diverticulitis.
POSTOPERATIVE DIAGNOSIS: Acute diverticulitis with obstruction.
ESTIMATED BLOOD LOSS: Minimal.
COMPLICATIONS: No immediate complications.
DESCRIPTION OF PROCEDURE: After obtaining informed consent, the patient was taken to the operating room and laid in supine position. General endotracheal anesthesia was induced. Pre-op antibiotics were given. An infraumbilical incision was made. This was carried down through subcutaneous tissue and fat until I arrived at the fascia. Incision was made in the fascia. A 10-12 port was inserted into the abdomen. The abdomen was insufflated with CO2. I placed 3 other 8 nun ports. The robot was then docked. I then proceeded with an extensive lysis of adhesions. I dissected out the sigmoid colon. There was a large amount of chronic inflammation. I dissected down to just above the rectum and I dissected up toward the descending left colon. Once I had completely dissected and freed out the majority of the diseased portion of the sigmoid, I used the robotic stapling device and I fired this proximal and distal to the diseased portion of the colon. An incision was made in the suprapubic area. The colon was removed out of the abdomen. I checked to make sure I had adequate hemostasis. I then proceeded to dissect down the descending colon attachments so I could bring this down toward the remaining Hartmann pouch. I dissected as much as I could of the lateral peritoneal reflection. However, I did not have adequate length in order to provide a tension-free anastomosis. Therefore, I had to convert to an open procedure, making a lower abdominal incision. I was then able to dissect out the remaining lateral peritoneal reflections up to the splenic flexure. This gave me adequate length in order to bring down my descending colon for my anastomosis. I used a pursestring device on the very end of the left descending colon. I placed an anvil after sizing the anus and rectum with the EEA. The EEA device was then placed from the anus into the rectum. The pin was fired just anterior to the staple line. The anvil was placed down with the descending colon. The EEA was fired. I did reinforce portions of my circular anastomosis with 3-0 silk suture. I checked to make sure that I had adequate complete donuts, which I did. I irrigated out the abdomen. I approximated and closed the fascia using a running #1 PDS suture. I irrigated out the subcutaneous tissue. I approximated and closed all incisions with staples. The patient tolerated the procedure well.
10/2017 – Lab Report: SURGICAL PATHOLOGY EXAM
Note: All result statuses are Final unless otherwise noted.
Tests: (1) SURGICAL PATHOLOGY EXAM (SURG)
Specimens: A) – Large Intestine, Sigmoid Colon
B) – Large Intestine, Sigmoid Colon, ANASTOMOTIC RINGS
Colon, sigmoid, segmental resection:
Diverticular disease complicated by acute diverticulitis, diverticular abscess, and acute serositis with adhesion formation
No dysplasia or malignancy
Colon, sigmoid, anastomotic rings, resection:
Two fragments of colon wall without significant pathologic abnormalities
No dysplasia, acute inflammation or malignancy
Clinical Information Diverticulitis with abscess
Received in formalin and labeled with the patient’s name and medical record number are two specimens.
Received is a portion of the sigmoid colon measuring 20.5 cm in length and varying from 2.0 to 4.0 cm in diameter. Serosa coating the segment of bowel is showing focally yellowish discoloration, fibrin adhesions and hemorrhage. Definitive perforation site is not grossly identified.
The specimen is opened and reveals numerous diverticular openings.
Located in the center of the specimen is an area of marked stenosis with only about l cm of open luminal diameter. Sectioning through the segment reveals numerous diverticular openings. Several of the diverticular openings extend to close proximity of free serosal surface that is coated with fibrin and hemorrhage. Definitive microabscesses are absent.
Multiple representative sections in total of five.
Received are two anastomotic rings measuring 2.5 x 2.2 x 1.7 cm and 1.4 x 2.0 x 1.5 cm. Representative section of each submitted in two.
A, B. Microscopically examined.