Case 1 Report 3 Operative Report

Kristina Sako

Patient name: Brenda C. Seggerman

Patient ID: 903321

Date of admission: 03/27/----

Date of surgery: 03/27/----

Surgeon: Rosemary Bumbak, MD

Assistant: Michael Gerard, DO

Anesthesia: General endotracheal by Dr. Avalon

Estimated blood loss: Approximately 1000 mL, requiring transfusion of 2

units of whole blood.

Specimen removed: Portion of the left fallopian tube containing the ectopic
pregnancy.

Preoperative diagnosis: Left tubal ectopic pregnancy.

Postoperative diagnosis
1. Ruptured left tubal ectopic pregnancy
2. Hemoperitoneum.
3. Pelvic adhesions.
Surgical Procedures
1. Exploratory laparotomy.
2. Partial salpingectomy.
3. Evacuation of hemoperitoneum.
4. Lysis of adhesions.

PROCEDURE IN DETAIL: The patient was prepped and draped in the usual
manner and placed under adequate general anesthesia. A Pfannenstiel
incision was performed and carried through skin and subcutaneous tissue,
fascia, and the peritoneum. The peritoneal cavity was entered. The
hemoperitoneum was noted, and approximately 500 mL of blood was rapidly
evacuated from the pelvic cavity, as were large clots. Following this, the
bowel was packed away from the pelvic area with packing laps. A retaining
retractor was introduced. The left fallopian tube was noted. A large tubal
ectopic pregnancy was noted, affecting approximately the distal half of the
fallopian tube.

Following this, a Heaney clamp was placed in mesosalpinx and another

curved Heaney clamp was placed in the proximal aspect of the left fallopian
tube beyond the area of the ectopic pregnancy. A partial salpingectomy was
then performed, removing the portion of the left fallopian tube containing
the ectopic pregnany. Heaney clamps were then replaced with sutures of No.
1 Vicryl. Hemostatsis was checked again, and no bleeding was detected.
Further evacuation of blood and blood clots was then performed. The right
fallopian tube was noted to be covered with adhesions, both tubo-ovarian
and tubo-uterine adhesions. The adhesions were then sharply lysed, freeing
the right fallopian tube. Hemostasis was checked again. No bleeding was
detected.

Mild serosal abrasion was noted from the area where the ectopic pregnancy
was apparently attached to the bowel. This was not bleeding and was very
superficial. Hemostasis was checked, and no bleeding detected.

The peritoneum was then closed continuously with 0 chromic suture. He

fascia was approximated with interrupted figure-of-8 stitches of Vicryl, and
the skin was approximated with the staple gun.

The patient tolerated the procedure well and left the operating room in
satisfactory condition. All counts were correct. Blood loss was estimated at
1000 mL, which was replaced with 2 units of whole blood while in recovery.
___________________
Rosemary Bumbak, MD
Obstetrics & Gynecology

KS: XX
D:03/27/----
T: 03/27/----