Pathology was severe UC. I just found this report here is what went on for the surgical procedure. If anyone is interested, The doc probably found more problems than she really wanted to deal with.
Me thinks I was pretty sick.
By the way my bladder is just getting over the trauma from the foley catheter.
Necrotic rectum to level of pelvic floor, retroperitoneal
abscess, inflammation of the colon to the distal sigmoid
ion of Procedure
Patient was identified in the preoperative holding area by
the attending surgeon and was brought back to the
operative suite. Patient was positioned on the operating
table in the supine position again identified by the
operating surgeon and anesthesia was induced
uneventfully. Prior to prepping and draping a patient a
rectal exam was performed under anesthesia which
revealed nodular mucosa as well as a tight stricture at
7 cm from the anal verge. Patient was then
prepped and draped in the standard fashion. A midline
incision was made around the umbilicus using a knife and
the subcutaneous tissues were dissected to the fascia
using Bovie cautery. The midline of the fascia was then
grasped and elevated and the abdomen was entered
sharply. On initial inspection of the abdomen no
obvious fecal contamination was noted. The sigmoid
colon was identified and the white line of Toldt was
incised. Beneath the colon after incising the white line of
Toldt a large retroperitoneal abscess was visualized. The
abscess cavity was entered and copious amount of
malodorous stool and pus was expressed from the
retroperitoneum. The sigmoid colon was then
dissected laterally to medially off of the abdominal
wall and the abscess was found to be tracking down
around the rectum. The rectum was visualized and was
found to be frankly necrotic. Using a combination of blunt
dissection and Bovie cautery the mesorectum was
dissected away from the surrounding pelvic wall down to
an area of rectum that on palpation was felt to be intact.
A contour stapler was used to transect the rectum. The
rectal stump was then elevated from the pelvis, there was
copious remaining necrotic tissue and stool which was
debrided and the pelvis was irrigated. The rectum was
noted to be frankly necrotic with many obvious areas of
perforation, the distal sigmoid colon was additionally
noted to be thickened and inflamed without
obvious perforation or stricture. The remaining
retroperitoneum was then explored, the left ureter was
identified, and any remaining pockets of pus or
stool were drained and irrigated. No further bowel or
colon was noted to be abnormal in appearance. After
sufficient drainage and irrigation of his intra-abdominal
abscesses, a left-sided colostomy was formed. A
small circular incision was made on the left side of the
abdomen using Bovie cautery. The subcutaneous fat was
dissected using Bovie cautery, the anterior sheath was
opened using Bovie cautery the muscles of the rectus
sheath were split and the posterior sheath was incised.
The sigmoid colon was then passed to the hole. At this
point 3 JP drains were placed, the left-sided JP drain was
placed in the pelvis. The right lower JP was placed in the
retroperitoneum around the area of the kidney, and the
right upper JP was placed in the paracolic gutter. The
fascia was then closed with a running #1 loop PDS. The
skin was loosely stapled. The colostomy was then
opening the distal staple line and using
chromic suture. An ostomy appliance was applied. The
patient was then awoken from anesthesia
uneventfully and was transferred to the leu for close
monitoring given the findings of severe contamination
during this case.
Rectum and distal sigmoid
Estimated Blood Loss
See anesthesia note
3 19 French channel JPs placed
Instrument and Sponge Count Correct?
Complications of Procedure
Condition of Patient at Time of Transfer
(x_) I was personally present throughout the entire procedure.
L) I was present during (or personally performed) the key portions of this procedure, which included _, as well as
other portions. I was immediately available for the entire procedure between
opening and closing.
L) I was personally present during the key portions of this procedure which included _. Dr. _ was immediately
available for the remainder of the procedure.
Post Edited (Old Mike) : 2/26/2022 5:56:21 PM (GMT-7)