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asbryobvrz · Wysłany: Pią 21:08, 04 Mar 2011

Reoperation after appendectomy three cases reflect

Appendicitis, after the onset of the 4th hospital stay. examination: mild right lower quadrant muscle health, and McNamara point tenderness,[link widoczny dla zalogowanych], rebound tenderness positive, no palpable mass. intraoperative see the appendix stump in the pouch suture healed, sutures clearly visible, tissue had no swelling, 3cm at the bottom can be seen from the greater omentum was wrapped in rope-like material articles, blunt dissection is recognized as the distal end of boring, long 4cm, crude I.5cm, congestion, a high degree of swelling, thickness, film pus moss layer, the proximal lumen has been occluded central parts - d 'block bezoars, no abnormalities within the distal ileum lOOcm. resection of residual nausea tail, and pathology of acute exacerbation of chronic appendicitis. Experience the end of the case may be boring residues When the first operation because of poor exposure, or lack of surgeon experience, the appendix in the stretch when adhesions break, postoperative nausea does not identify the removal of the tail is complete. boring residues distal end of the body to form a tube closed at both ends of occlusion cavity,[link widoczny dla zalogowanych], the appendix can not be discharged mucus secreted by mucous membranes, the stimulation in fecal secondary bacterial infection, but the end of residual inflammation causes nausea. Prevention is the key residues in the appendix fully reveal the surgical field,[link widoczny dla zalogowanych], not when the force pulling the end bored too large, too fast, cut the end of appendix specimens boring after check is complete. Case 2: Male, 42 years old. I987 in March because of . I988 metastatic in May due to right lower abdominal pain 2 days in hospital. examination: right lower abdominal health, Maxwell point tenderness, rebound. no palpable mass. intraoperative down and see the greater omentum adhesion ileocecal , after the separation zone along the colon to find a cords, and the surrounding tissue adhesion, see the complete appendix after the separation, long 6cm, crude lcm, congestion. edema,[link widoczny dla zalogowanych], serosal pus moss. 2cm from the top of the cecum wall of the appendix shows the root seam pockets line, healing, and no swelling, retrograde appendectomy. pathologic examination: acute cellulitis appendicitis. full e when. realize that the case might be mistaken surgery the appendix caused by cutting residues other organization, or misdiagnosis double appendix deformity. Although Double appendix rare clinical deformity, surgery should be carefully examined to avoid misunderstandings. appendectomy surgery should be to find meeting point of three marked with a colon, to prevent the intestinal fat down by traction with the colon, appendix, lymph nodes and other organizations as resection, resection specimens should be routinely sent to pathology. Case 3: Female, 30 years old. I985 in at 10:00 on December 9 due to acute appendicitis at appendectomy spinal anesthesia, surgery, see the appendix in the posterior blind, long-lOcm, Crude lcm, congestion, edema, serosal pus moss. no blood in the abdominal cavity, no probe attachment. I985 I1 in December after a bowel movement at 1:00 dizziness, abdominal pain, nausea, vomiting, blood pressure, 10.7 / 8 . OkPa, pulse 120 beats / min, mild abdominal muscles full health, there is tenderness and mild rebound tenderness (in the right lower abdomen was), right lower quadrant can be removed without coagulation of blood, knowing detailed history of the last menstrual asked 2 months ago often lower abdominal pain, comes an increase in diagnosis of ruptured ectopic pregnancy. reoperations see a free intraperitoneal blood and blood clots lO00ml, the Ministry of the right uterine horn of pregnancy, from the corner to the umbrella-side thickening, swelling around the egg size. umbrella terminal blood spills, the normal uterus and the left side, line on the right corner and right uterine tubal resection, intraoperative blood lost with 800ml, postoperative recovery was smooth, cured and discharged. 1st surgical pathology specimens : Acute cellulitis appendicitis, 2nd pathology specimens: see fallopian tube in the degeneration of chorionic villi. Experience in this case the right tubal ectopic pregnancy with acute suppurative appendicitis, rarely seen clinically. ruptured ectopic pregnancy in this case , and stimulation and abdominal surgery Shield increased abdominal pressure during defecation. For women appendicitis patients,[link widoczny dla zalogowanych], in addition to detailed history before surgery, the surgery should be routine uterine exploration and accessories, especially found in patients with suspected appendicitis or chronic disease is not obvious appendicitis who, to prevent missed diagnosis of ovarian cyst, tubal pregnancy, uterine fibroids and other gynecological diseases. preoperative gynecological diseases should be considered when associated with countermeasures.