Wednesday, February 28, 2007
Tales from the Operating Room XI........
Alas, my blogging muse had left me for a time, but it has returned. With the kind of post everyone likes.......one with gross pictures!!!
A 30-ish lady with diabetes and three week history of abdominal pain. She had seen her family doctor and obtained plain films which were unrevealing. She was also treated for a UTI. Her pain worsened to the point where she was sent to the hospital. She had severe lower abdominal pain and an elevated WBC. Here are the CT scans...
Abdominal phlegmon with inflammitory changes in the soft tissue.
Air within the phlegmon
More air, tracking inferiorly
Air tracking down into the labia
Here is the reconstruction. So inflammation and air where there should not be....off to the OR.
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THE FOLLOWING IMAGES MAY BE OFFENSIVE !!!!!
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YOU HAVE BEEN WARNED!!!!!!
The gray stuff in the circle is dead fascia. Her external oblique has been destroyed by the infection. The yellow line indicates her inguinal ligament which has also become infected. When the dead tissue was debrided a tract was found leading into her peritoneal cavity. This lead to the theory that this came from a ruptured appendix that had tracked outwards.
She was taken to the ICU and brought back to the OR the next day. Further debridement was undertaken and we excised her external oblique and her anterior rectus sheath inferiorly. We placed a VAC on the third trip to the OR. We changed the VAC every other day for about two weeks until it was felt she was ready for skin grafting. Here is what it looked like:
Alas, my blogging muse had left me for a time, but it has returned. With the kind of post everyone likes.......one with gross pictures!!!
A 30-ish lady with diabetes and three week history of abdominal pain. She had seen her family doctor and obtained plain films which were unrevealing. She was also treated for a UTI. Her pain worsened to the point where she was sent to the hospital. She had severe lower abdominal pain and an elevated WBC. Here are the CT scans...
Abdominal phlegmon with inflammitory changes in the soft tissue.
Air within the phlegmon
More air, tracking inferiorly
Air tracking down into the labia
Here is the reconstruction. So inflammation and air where there should not be....off to the OR.
X
X
X
X
X
X
X
X
X
X
X
X
X
X
THE FOLLOWING IMAGES MAY BE OFFENSIVE !!!!!
X
X
X
X
X
X
X
X
X
YOU HAVE BEEN WARNED!!!!!!
The gray stuff in the circle is dead fascia. Her external oblique has been destroyed by the infection. The yellow line indicates her inguinal ligament which has also become infected. When the dead tissue was debrided a tract was found leading into her peritoneal cavity. This lead to the theory that this came from a ruptured appendix that had tracked outwards.
She was taken to the ICU and brought back to the OR the next day. Further debridement was undertaken and we excised her external oblique and her anterior rectus sheath inferiorly. We placed a VAC on the third trip to the OR. We changed the VAC every other day for about two weeks until it was felt she was ready for skin grafting. Here is what it looked like:
Sorry for blurriness. The bed had good granulation. A graft was placed and unfortunately failed. It was a tough place to get a graft to stick, her diabetes may have also contributed to the failure. She was discharged and was doing wet-to-dry dressing changes. Her wound is contracting nicely as of yesterday.
Labels: Tales from the Operating Room
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