NECC – Medical Terminology
Assignment Digestive System Case Studies
Define the terms for the 4 reports that are numbered and in bold on the corresponding answer pages
OPERATIVE REPORT
PREOP. DIAGNOSIS: Left inguinal hernia.
POSTOP. DIAGNOSIS: Left inguinal hernia.
NAME OF OPERATION: Laparoscopic preperitoneal inguinal hernia repair with mesh on the left.
ANESTHESIA: General 1.endotracheal.
INDICATIONS: Twenty-four year old who has had a reducible bulge in the
left groin which is causing pain.
PROCEDURE IN DETAIL:
The patient was brought the operating room and placed
upon the operating room table where general endotracheal 2.anesthesia was administered. He received 3.intravenous antibiotics preoperatively and pneumatic compression boots were placed intraoperatively. The abdomen and groin were prepped and draped in the usual sterile fashion. An 4.infraumbilical incision was then made slightly to the left. This carried down to the left 5.anterior rectus fascia. The space just anterior to the posterior rectus fascia was then penetrated with the balloon dissector and this was then inflated. This resulted in a good clearance of the preperitoneal space. A 5 mm. incision was made in the 6.suprapubic area and a 10 mm. incision made between the two. A 10 mm. port was introduced in the middle incision and a 5 mm. port in the low incision. The cord was identified by pulling on the scrotum. A sac was completely dissected free from the cord. 7. Laterally the peritoneal attachments were taken down bluntly. Medially the pubic tubercle was identified along with Cooper’s ligament. The cord was then thinned of its associated 8.lipoma and completely encircled. A 5 x 3 inch mesh was brought to the field tapered at the ends and split with a slit in the upper outer corner. This was then inserted and placed around the cord. Staples were used to fix this mesh to the Cooper’s ligament, pubic tubercle and anterior abdominal wall. Laterally no staples were placed below the level where the head of the stapler could be felt through the skin. This was performed this way to avoid any entrapping any nerve and causing any kind of chronic pain syndrome. The staple was placed to fix together the two limbs of the mesh and this reconstitutes the internal ring. At the completion this appeared securely and laid out lying flatly against the abdominal wall. The area was deflated with holding down the lateral corner and the 9.peritoneum was allowed to drape over this without any kink. All ports were then removed. The two 10 mm. ports were closed with a figure-of-eight Vicryl stitch. Antibiotic irrigation was applied. The wounds were closed with a running #4-0 Vicryl subcuticular stitch on the skin. Steri-Strips and dry sterile dressing were then applied. Patient tolerated the procedure well and was transferred in stable condition to the recovery room.
Answer Page – Operative Report
1. endotracheal
2. anesthesia
3. intravenous
4. infraumbilical
5. anterior rectus fascia
6. suprapubic
7. laterally
8. lipoma
9. peritoneum
CHIEF COMPLAINT: Right 1.colonic cancer
HISTORY OF PRESENT ILLNESS: Seventy-nine year old with a previous history of 2.duodenal
ulcer. He had been placed on Prevacid and this resulted in his being symptom free. However, by screening he was detected to have occult blood in his stool. He therefore underwent a 3.colonoscopy which revealed a right colonic 4.adenocarcinoma by biopsy. The patient denies any changes in his bowel movements, abdominal pain, weight loss.
PAST MEDICAL HISTORY: Hypertension; heartburn; peptic ulcer disease.
PAST SURGICAL HISTORY: 5. Radical prostatectomy in 1986.
MEDICATIONS: Prevacid, Zestril, atenolol, Hytrin
SOCIAL HISTORY: The patient is interested in
mind/body connections. He used to smoke and has quit. He does not drink alcohol.
REVIEW OF SYSTEMS: The patient walks five miles a day (does not use a car). He is
completely free of any cardiopulmonary symptoms, has no shortness of breath and feels very fit.
PHYSICAL EXAMINATION: Youthful, fit-appearing
CHEST: Clear.
CARDIAC: Regular in rate and rhythm.
ABDOMEN: Soft; a well-healed lower midline incision; no palpable mass.
EXTREMITIES: Without clubbing, cyanosis or edema.
IMPRESSION: Right colonic cancer. This requires right 6.hemicolectomy for
potential cure. The patient is a candidate for laparoscopic hand-assisted colectomy. I have explained to the patient that this is a new approach to colonic operations. I have explained also that because if it is hand-assisted, many of the advantages of the open procedure remain along with the advantages of laparoscopy, which include better visualization and rapid recovery. I have explained that the actual anastomosis is done in the same fashion as the open procedure. The patient understands and wishes to proceed with this approach.
HISTORY AND PHYSICAL EXAMINATION
Answer Page- History and Physical Examination
1. .colonic cancer
2. duodenal ulcer.
3. colonoscopy
4. adenocarcinoma
5. Radical prostatectomy
6. hemicolectomy
Operative Report
PREOP. DIAGNOSIS: Right colonic cancer.
POSTOP. DIAGNOSIS: Right colonic cancer. –
NAME OF OPERATION: Hand assisted laparoscopic colectomy.
ANESTHESIA; General endotracheal.
INDICATIONS: The patient has a biopsy proven right colonic cancer.
PROCEDURE: The patient was brought to the operating room, placed supine on the
operating table where general endotracheal anesthesia was administered. He had received a full bowel prep including oral antibiotics. He received intravenous antibiotics preoperatively. Pneumatic compression boots were placed intraoperatively. The abdomen was prepped and draped in the usual sterile fashion. The supraumbilical incision was made, and the fascia was entered under direct vision. A 12mm port was introduced into the abdomen and this was explored. There were some adhesions in the lower abdomen, and the liver was slightly 1.cirrhotic. The second 10mm port was introduced in the 2.subxiphoid area and the incision was then lengthened for the hand assisted sleeve which was placed in the umbilical area. The right colon was then palpated and the tumor was found. This was near the cecum. The colon was mobilized from lateral to medial, and pulled around from the cecum to the transverse colon once the ureter was identified. Once this was accomplished, the colon was pulled into the hand assisted sleeve and mobilized. The incision was enlarged slightly because I was not satisfied with the mobilization of the colon. It turned out that there was a slight twist in the small bowel and then allowed the colon to be delivered. There was no contact with the colonic cancer in the wound since it was covered at all times with the sleeve.
The middle colic was then identified and a large branch was taken. This was then followed down to the right colic and ileocolic vessels which were taken separately. The mesentery between these were then taken by serial clamping and ligation. Approximately 15cm from the 3.ileocecal valve; the ileum was freed up and cleared. Similarly in the mid-transverse colon, the colon was freed. A side to side, functional end to end staple 4.anastomosis was then constructed using a 75mm stapler fired across the anterior mesenteric aspect of the ileum and colon, and then fired across the previously made hole. This was inspected, found to be nicely air tight. This was covered with 5.omentum and the mesenteric defect was closed with a running #4-0 PDS. This was then replaced into the abdomen paying careful attention to not twisting the bowel. The entire abdomen was irrigated and felt to be free of bleeding.
The upper abdominal wound was then closed with a #1 PDS on the fascia. The midline abdominal wound was closed with a running, #1 PDS followed by antibiotic irrigation. The
skin was then closed with staples. Dry sterile dressing was then applied. The patient tolerated the procedure well and was taken in stable condition to the recovery room.
OPERATIVE REPORT
Answer Page – Operative Report
1. cirrhotic
2. subxiphoid
3. ileocecal valve
4. anastomosis
5. omentum
