DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Wound dehiscence with abdominal hemorrhage.
POSTOPERATIVE DIAGNOSIS: Wound dehiscence with arterial bleeding from free rectus abdominis muscle edges with subsequent bleeding from subcutaneous tissue.
PROCEDURES PERFORMED:
1. Local wound exploration with suture ligation of bleeding vessels.
2. Superficial abdominal wound exploration with control of abdominal hemorrhage using hemostatic Surgicel.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: MAC.
ESTIMATED BLOOD LOSS: 1000 mL.
COMPLICATIONS: None.
SPECIMENS REMOVED: None.
DRAINS: None.
INDICATIONS FOR PROCEDURE: The patient is a (XX)-year-old male who has had a complicated postoperative course following a Hartmann’s procedure for perforated diverticulitis. The patient has been admitted to the hospital for some time, recuperating from an intra-abdominal abscess, which was drained. He was noted to have some bleeding from the inferior aspect of his surgical wound, which was initially controlled with silver nitrate. Prior to operation, the patient was noted to have increased bleeding from the wound, and on inspection by the surgery team was noted to have pulsatile bleeding from this wound. There was a significant amount of blood loss associated with this, and therefore, it was deemed difficult to control with pressure and silver nitrate alone. For this reason, the patient was explored locally in order to control this hemorrhage. This was an emergent procedure, and therefore, informed consent was not obtained.
DESCRIPTION OF PROCEDURE: The patient was placed in the supine position. After induction of anesthesia, the wound was prepped and draped in the usual sterile fashion. Arterial bleeding was noted from the right lateral margin of the wound, and this was controlled with a 3-0 silk suture. Bleeding continued to well up from the base of the wound, and on further inspection, it was noted that there was a large amount of hematoma in this area. This was manually evacuated, and we were able to identify the lateral margins of the rectus muscle. The wound was clearly dehisced, and bleeding appeared to be emanating from deep within the wound. Electrocautery was then used to obtain hemostasis on the lateral wound margins, including the subcutaneous tissue, and the rectus abdominis muscles.
The deep portions of the wound continued to well up with blood, and we proceeded to open the wound superiorly. This gave additional access to the wound, and three 3-0 silk sutures were used in figure-of-eight fashion to control this bleeding. The wound continued to ooze significantly, and therefore, Surgicel was packed into the wound. During this time, the patient had lost a significant amount of blood, and resuscitation was performed using blood products as well as crystalloid fluid. Ultimately, packing was removed, and the wound was inspected and appeared to be grossly hemostatic at that time.
The Surgicel was left in place, and a moist gauze dressing was placed over the wound. Gentle pressure was held on the wound using a 2.5 pound sandbag. The patient tolerated this procedure well, and there were no complications encountered.
