[Verified Answer]: Procedure performed: Primary procedure:…

Procedure performed: Primary procedure: Sigmoid colectomy Additional procedure detail: Small bowel resection and appendectomy Preoperative diagnosis: Acute diverticulitis, sigmoid colon Partial small bowel obstruction Postoperative diagnosis: Acute diverticulitis, sigmoid colon Partial small bowel obstruction Estimated blood loss: 100 ml Specimens removed: Sigmoid colon, small bowel loop Indications: The patient had apartial small bowel obstruction. The patient was unable to eat on various trials and has not had a bowel movement for over a week. Every time patient is fed, patient gets nauseated and bloated. Details of procedure: The patient was in the lithotomy position and a midline incision was made from just above the umbilicus down into the pubic area. Dissection was done through the morbidly obese abdomen to the midline fascia which was incised. As we approached the abdominal cavity there was a tremendous amount of inflammation and edema. Therefore, dissection was done through this but it was obvious that it would be difficult to enter in the lower abdomen and thus the incision was enlarged superiorly and entry was gained through linea alba which was unaffected. I worked my way down. There was small bowel adhered to the sigmoid colon and both the structures were then in turn adhered to the anterior abdominal wall. As I easily dissected into this there was a small pus pocket which evacuated but was immediately suctioned out from the peritoneal and preperitoneal areas. The fascia was unaffected by any spillage. Dissection was then continued onto the pubic area. The small bowel was adhered to this phlegmon. It was sharply and bluntly dissected off. There was one loop which was extremely inflamed. I was unable to tell whether this would be viable and thus this loop was resected by taking down the mesentery and doubling the bowel doing a GIA anastomosis and removing the affected portion by applying a GIA across the enterotomy. The mesentery was closed with 3-) Vicryl. Hemostasis was excellent. Attention was turned to the area of sigmoid colon that had created the diverticular abscess. Thelateral portions of the sigmoid were taken. The mesentery of the affected part was taken with the LigaSure. The sigmoid was doubled on itself and a GIA anastomosis similarly done and the specimen removed by placing a TA 90 across the bowel. Copious irrigation was done. The anastomoses stayed pink. All areas of dissection were checked and found to be nonbleeding. The appendix was enlarged and appeared somewhat inflamed. The mesentery was taken down with the LigaSure. At the base a TA 30 was fired and the appendix removed. All areas were irrigated with warm saline and excess saline was removed. A final inspection was done. The atrium was instilled with half percent Marcaine with epinephrine. The midline fasciawas closed with #1 double-stranded PDS run from both ends with #1 Vicryl placed at 2 cm intervals. The skin was staple IDC-10-CM IDC-10-PCS