Medical Specialty:
Gastroenterology
Sample Name: Stamm Gastrostomy Tube Placement
Description: Open Stamm gastrotomy tube, lysis of adhesions, and closure of incidental colotomy
(Medical Transcription Sample Report)
PREOPERATIVE DIAGNOSES:
1. Squamous cell carcinoma of the head and neck.
2. Ethanol and alcohol abuse.
POSTOPERATIVE DIAGNOSES:
1. Squamous cell carcinoma of the head and neck.
2. Ethanol and alcohol abuse.
PROCEDURE:
1. Failed percutaneous endoscopic gastrostomy tube placement.
3. Lysis of adhesions.
4. Closure of incidental colotomy.
ANESTHESIA: General endotracheal anesthesia.
IV FLUIDS: Crystalloid 1400 ml.
ESTIMATED BLOOD LOSS: Thirty ml.
SPECIMENS: None.
FINDINGS: Stomach located high in the peritoneal cavity. Multiple adhesions around the stomach to the diaphragm and liver.
HISTORY: The patient is a 59-year-old black male who is indigent, an ethanol and tobacco abuse. He presented initially to the emergency room with throat and bleeding. Following evaluation by ENT and biopsy, it was determined to be squamous cell carcinoma of the right tonsil and soft palate, The patient is to undergo radiation therapy and possibly chemotherapy and will need prolonged enteral feeding with a bypass route from the mouth. The malignancy was not obstructing. Following obtaining informed consent for percutaneous endoscopic gastrostomy tube with possible conversion to open procedure, we elected to proceed following diagnosis of squamous cell carcinoma and election for radiation therapy.
DESCRIPTION OF PROCEDURE: The patient was placed in the supine position and general endotracheal anesthesia was induced. Preoperatively, 1 gram of Ancef was given. The abdomen was prepped and draped in the usual sterile fashion. After anesthesia was achieved, an endoscope was placed down into the stomach, and no abnormalities were noted. The stomach was insufflated with air and the endoscope was positioned in the midportion and directed towards the anterior abdominal wall. With the room darkened and intensity turned up on the endoscope, a light reflex was noted on the skin of the abdominal wall in the left upper quadrant at approximately 2 fingerbreadths inferior from the most inferior rib. Finger pressure was applied to the light reflex with adequate indentation on the stomach wall on endoscopy. A 21-gauge 1-1/2 inch needle was initially placed at the margin of the light reflex, and this was done twice. Both times it was not visualized on the endoscopy. At this point, repositioning was made and, again, what was felt to be adequate light reflex was obtained, and the 14-gauge angio catheter was placed. Again, after two attempts, we were unable to visualize the needle in the stomach endoscopically. At this point, decision was made to convert the procedure to an open Stamm gastrostomy.
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