OPERATIVE REPORT (3:00)
PREOPERATIVE DIAGNOSIS
Cholecystitis.
POSTOPERATIVE DIAGNOSIS
Cholecystitis.
PROCEDURE
1. Open cholecystectomy.
2. Common bile duct drainage via T tube.
INDICATIONS A 65-year-old woman who was found at home, 1 day prior to operation, in a very
confused state. It reveals severe diabetic ketoacidosis. Over the ensuing 36 hours, she developed the septic appearing picture requiring pressure support and intubation. Prior to intubation, she complained of right upper quadrant pain and ultrasound reveals that some of her gallbladder with air in biliary tree. No biliary duct dilatation was noted and no stones are noted. Due to the patient continuing downhill course, she has been taken to the operating room for emerging biliary drainage.
OPERATIVE FINDINGS A very distended, tense gallbladder which was very edematous was noted. There were no surrounding adhesions or inflammation. Pus was noted within the gallbladder. The common bile duct was noted to be dilated, and when it was opened, purulent bile drained out as well. A 12-French T tube was placed without complications.
OPERATIVE PROCEDURE Informed consent was taken from the patient during her loosen denture hole. She was taken in the operative room, plus pre operative room paper work and general anesthesia taken without difficulty. Patient had been previously intubated in intensive care unit. Have in, prepped and draped in a standard surgical fashion. RT sub [censored] incision in fashion. Ammonia was entered. The gallbladder was noted to be emphysematous and edematous. Gallbladder was removed by sharp dissection using a cautery. Cystic artery was dissected free, clamped and divided. It was ligated with 2-0 silk suture. This is the duct similar dissected free clamp divided and tied to 2-0 silk suture. Common bile duct is noted to be dilated. A long incision was fashioned along the anterior portion of common bile duct. Upon entering the bile duct purulent bile was drained. A 12-French T tube was then placed into the bile duct, and the bile duct was closed around the T tube using 3-0 Vicryl suture. The T tube was then brought out a stab wound in straight fashion. A #10 Jackson-Pratt (JP) drain was placed in the Morison's pouch. Posterior fascia was closed with a 0 Vicryl running suture. The anterior fascia was closed with #1 PDS running suture. The skin was closed with staples. Drains were secured. The patient was taken to the intensive care unit intubated and in critical but stable condition.