Surgery Important 2024 progress in English

Surgery Presentation

1. TREATMENT PLAN DR. ASHAR BIN DAWOOD

2. Initial Plan Of Treatment: Admit the patient Send all baselines Chest X-Ray Abdominal and Inguinoscrotal Ultrasound

3. Final Treatment Plan We planned an exploratory laparotomy for this patient. The fistula was excised and enteric tract was repaired. Lymph node biopsy was taken to rule out any malignancy. The wound was left open for better healing.

4. Post Operative Care He was kept on NPO for approx. 2 days till he passed the flatus. After that we kept him on liquid diet, then semi solid diet and now he is taking regular diet.

5. Surgical Treatment We planned an Exploratory Laparotomy for this patient. SURGICAL PREPARATION: It is an elective surgery of the gut so we did gut preparation of the patient. Gut Preparation was done by: Switch to clear fluids 3 days before the surgery. Don’t eat or drink anything 6 hrs before the surgery. Minimise the fecal load by taking laxatives. Stop mechanical clearing by doing enema.

6. STEPS OF THE PROCEDURE: Under aseptic measures, lower midline incision was given and abdomen was opened . Perforation was found. Dense adhesions were found, so a dhesionolysis was done. Resection end to end anastomosis (RETEA) of ileum (single layer) was done to prevent obstruction . Repair of anterior wall of sigmoid colon (single layer) done. Small intestine resection was done. Abdominal wash with Normal Saline and closed with sutures. Drain placed in the pelvis Hemostasis done, Wound closed.

7. Surgical Findings Middle part of sigmoid colon herniated through the defect and perforation. Terminal Ileum adhesions with sigmoid colon. Post Op Final Diagnosis: Enterocutaneous Fistula Post Op Prognosis: Patient post-op recovery was uneventful. He passed flatus and stool on the 3 rd day. Slight wound infection was seen which was treated by daily dressing and antibiotics. Patient was kept NPO for 3 days, then started on oral sips and liquids. Soft oral diet was started on 8 th post op day. No adverse events were noted. Patient is now taking regular diet without any gastrointestinal symptoms.