The patient was identified in the ICU. He was continued on fentanyl and Versed drips for sedation. His dressing was taken down. This showed that there continued to be brownish fluid drai
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Preoperative Diagnosis(es): Necrotizing pancreatitis.
Postoperative Diagnosis(es): Necrotizing pancreatitis.
Procedures Performed: Irrigation and debridement of pancreatic necrosis.
Anesthesia: ICU sedation with fentanyl and Versedßagain sedation medications in the ICU.
Start time 4:00 pm
Stop time 4;58 pm
Estimated Blood Loss: None.
Complications: None.
Findings: Moderate amount of brown, foul-smelling fluid with small chunks of debris
and necrotic fat from the pancreatic bed.
Indications: This is a patient who has had pancreatitis for about 2 months. He presented to this institution several days ago with a septic picture and necrotic and infected pancreatitis. He underwent one debridement in the operating room, and he has had some dressing changes that were heavily soaked with foul-smelling brown drainage. A bedside debridement, drainage, and irrigation are planned for today.
Procedure: The patient was identified in the ICU. He was continued on fentanyl and Versed drips for sedation. His dressing was taken down. This showed that there continued to be brownish fluid draining from where the wound had tracked into his pancreatic bed. This was also explored first with the hand, and this was quite an extensive deep wound after sweeping a bit in the wound bed with a finger. Once the hand was removed, moderate amount of brownish fluid was expressed from the wound. The wound was then irrigated with 0.5 L of saline which was suctioned out. Once the fluid started to clear up, all the excess fluid was suctioned out. A moist Kerlix was then stuffed into the wound. Dr. Schreiber was present and scrubbed for the entire case. Plan is to continue the debridement twice daily. Additionally, a posterior approach to get the remaining debri in the retro peritoneum is being considered either surgically or possibly by our Interventional Radiology colleagues.
Surgeon: ???????????????????????????????????????
Anesthesiologist
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