SOLVED478

PRE-OPERATIVE DX: Pneumoperitoneum POST-OPERATIVE DX: Perforated Gastric Ulcer with enteric peritonitis PROCEDURE: 1. Diagnostic Laparoscopy 2. Laparoscopic Oversew of Gastric Ulcer with Graham Patch INDICATIONS: Pt is a 62-year-old female who presented with 5 hours of severe, acute epigastric pain. Abdominal films revealed possible free air under the diaphragm. PROCEDURE: The patient was taken to the OR in the supine position. She was then placed under general anesthesia and intubated. Entry into the abdomen was obtained with a 2.0 cm incision just inferior to the umbilicus. Scopes were inserted. Upon inspection of the stomach, there was purulent fluid in the right upper quadrant around the liver and stomach. The suction irrigator was used to suction out the purulent fluid. There was an obvious ulcer on the anterior stomach in the pre-pyloric position. The edges of the ulcer were then cleaned and the ulcer was then oversewn with three 3-0 Vicryl sutures in figure of eight fashion. The needles were left on the figure of eight sutures and omentum was pulled over the ulcer to buttress it. The Vicryl sutures were placed through the omentum and tied over the ulcer to create a Graham Patch. A temporary wound drain was brought
SCIENCE
HEALTH SCIENCE
NURSING

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