Tuesday, December 22, 2009
Night time gallbladders
I usually don't do laparoscopic cholecysyectomies in the middle of the night. Rare is the case you can't just hydrate, put on antibiotics overnight and operate the next day. But this guy needed emergent surgery; septic, confused, white count near 30,000. The gallbladder was basically dead; a flaccid, ashy-hued mishmash of once vibrant tissue. Furthermore, the edema from the inflammation was so intense, the right colon was being compressed (see CT) leading to significant cecal dilatation.
Cases like this usually go suprisingly smoothly, even with the laparoscope, because the inflammatory reaction allows for easy dissection of anatomic planes. Two days later he was eating pizza and asking when the hell I was going to let him go home. He had Christmas presents to buy.
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One of the things I love about lap choles. Very few things exemplify 'cut to cure' as well.
Merry Christmas to you and your patient!
I am always concerned about this patient sneaking under the ER radar. We see two or three a year. Just as you said.... when called for "cholecystitis" at 1AM... I don't get excited.. but I have learned to ask a straight forward question; "How does the patient look". I am amazed that if I don't ask this... I might come in the next morning to find a septic patient.
no radiological drainage and do it in the morning?
I always take this very seriously in the 50 year old male. They are always the ones who go south in a hurry. I have never been sorry to come in in the middle of the night for one of these.
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