Thursday, March 30, 2006
Tales From the Operating Room VIII.....
Paying back the man for last weeks misdeeds. Many transgressions were made up for by this case, left for me on call by my partner. 30-ish with incarcerated bilateral hernias. Started on the right side. The scrotum was quite large but he had little distance between his internal and external rings, which are demonstrated below:
This left little room to work in. I had to enter the sac to withdraw the hernia contents from the scrotum. Look what I reeled in:
Looks to be his entire greater omentum had found a home in his scrotum. With his scrotum "decompressed" I was able to ascertain he had no large hernia on the left. I dissected out the sac and isolated the important testicular stuff. I then placed the omentum back in the sac:
Unfortunately his scrotum didn't show up too well in these pictures. I did this to try to facilitate the placement of the omentum back into the abdomen. This, along with increased paralytics, steep trendelenberg position, and 45 minutes of effort could not get it back inside. I elected not to extend his internal ring because his tissue was pretty weak. I tried stuffing it back in independent of the sac, but created bleeding by doing so. I ended up resecting about 60 percent of it and repaired him in my usual plug-and-patch fashion.
Paying back the man for last weeks misdeeds. Many transgressions were made up for by this case, left for me on call by my partner. 30-ish with incarcerated bilateral hernias. Started on the right side. The scrotum was quite large but he had little distance between his internal and external rings, which are demonstrated below:
This left little room to work in. I had to enter the sac to withdraw the hernia contents from the scrotum. Look what I reeled in:
Looks to be his entire greater omentum had found a home in his scrotum. With his scrotum "decompressed" I was able to ascertain he had no large hernia on the left. I dissected out the sac and isolated the important testicular stuff. I then placed the omentum back in the sac:
Unfortunately his scrotum didn't show up too well in these pictures. I did this to try to facilitate the placement of the omentum back into the abdomen. This, along with increased paralytics, steep trendelenberg position, and 45 minutes of effort could not get it back inside. I elected not to extend his internal ring because his tissue was pretty weak. I tried stuffing it back in independent of the sac, but created bleeding by doing so. I ended up resecting about 60 percent of it and repaired him in my usual plug-and-patch fashion.
Labels: Tales from the Operating Room
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