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Tuesday, January 14, 2014

High up Caecum and Difficult Appendicectomy

Posted by Dr Prahallad Panda on 9:13 PM Comments

Pain, fever and nausea/vomiting, Murphy’s triad points to appendicitis; an ultrasonogram supports the provisional diagnosis. Through Lanz (R) incision abdomen opened; usually a finger should be able to feel the appendix in abdomen. If, not felt, a portion of colon is brought out and traced to the coalescence of the all three tinea coli to the base of appendix.

English: A cat scan demonstrating acute append...
English: A cat scan demonstrating acute appendicitis (note the appendix has a diameter of 17.1mm) (Photo credit: Wikipedia)
 All went in vain, became frustrated, not to find the one; saw an enlarged right ovary that was mentioned to be normal in the ultrasonogram. But, I was after appendix. A little confusion, is the enlarged ovary the cause of pain, not appendix?
To my good luck, thought came to mind to feel upwards, high up, towards Gall Bladder, some structure similar to the feeling of a diseased appendix was felt, raising some hope and apprehension. Apprehension is that, is it something else? Not viewable, manipulated by one finger, together with the retraction of wound upwards by assistant, saw something that raised hope, still not very much forth coming.
Anyway, able to saw it at last; applied bob cocks and went for retrograde appendicectomy. Turned my view to the enlarged right ovary, on holding it with allies forceps, all watery fluid came out. Marsupialized and arrested all oozing.
Ohh, relieved.  At one time, was contemplating to open the abdomen fully in lower right paramedian plane.
Every case is a new case for a doctor. Appendicitis, both easy and difficult to diagnose; and the same is true for appendicectomy too.

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