NCCT Case 2

Robert, a senior in college, visited the Emergency Room due to pain in his lower right abdomen. Along with this pain, he had a 102’ temperature, and vomiting. He was diagnosed with acute appendicitis, and was scheduled for immediate surgery.

What are the greatest risks of untreated appendicitis? 

Rupture, perforation, peritonitis, sepsis, organ failure, death.

What surgical procedure is done to treat appendicitis? Describe the two common techniques for this surgery?

Appendectomy. Open requires a larger excision to view and remove the appendix, used for more complex situations (e.g., the appendix is perforated or gangrenous). Laparoscopic uses a small incision for a laparoscope (thin tube with a camera) to pass through to access and remove the appendix; benefits include a smaller scar, usually reduced pain, and normally a shorter hospital stay. 

What position should the patient be placed in for the surgery to remove the appendix? 

Supine. Because is a safe and stable position for the patient on the operating table. The supine position allows the surgeon the ability to view the appendix; and keeps the organs in a natural and easily accessible position.  

What is the name of the incision that is made for an open appendectomy? Why?

Mc Burney incision. This type of incision allows for good visualization of the appendix, causes minimal trauma to abdominal muscles, which encourages quicker recovery and causes less pain.

What are two major details does the surg tech need to know about the patient in order to be properly prepared for this case (in addition to open or laparoscopic)?

Weight – if the patient is obese, you need a long set of general instruments.  You also need an OR table that is able to hold additional weight.   

Age – if the patient is geriatric or pediatric, attention needs to be given to maintaining their body temperature, with a warming device.  Additional padding and positioning tools may also be needed to protect the patient's delicate skin and boney prominences.  

If the procedure is being done laparoscopically, what tool should be used to achieve a pneumoperitoneum? 

A Veress needle (a spring-loaded hollow needle), or a periumbilical trocar (a trocar – sharp-edged or blunt-tipped piercing instrument inside a cannula inserted near the navel) is used to achieve a pneumoperitoneum.