c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

Appendectomy: 31

A D V E R T I S E M E N T

   
 

In more than half the population, the appendix is partially or totally retrocecal. It may lie behind a floppy cecum and be easily mobilized, or it may be sealed behind the cecum by the cecal peritoneal reflections. The interposition of the cecum between the appendix and the abdominal wall may blunt the classic right lower quadrant peritoneal signs.      

Notes:

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Appendectomy: 32

A D V E R T I S E M E N T

   
 

If the appendix is retrocecal and retroperitoneal, it is necessary to mobilize the cecum from the lateral peritoneal reflection. Difficult exposure may require extension of one or both ends of the skin incision.       

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Appendectomy: 33

A D V E R T I S E M E N T

   
 

The appendix is mobilized into the wound and the base is visualized at its junction with the cecum. This exposure is achieved by gentle traction on the cecum. Because of its friability, the appendix cannot be used as a handle to expose the base. If the appendix is found to be normal, the terminal ileum is identified by its crista galli, and the distal ileum is delivered into the wound for a distance of two feet looking for a Meckle's diverticulum. If this is negative and another source of peritonitis is suspected, the McBurney incision is easily closed and a laparotomy incision made.     

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This page was last modified on 12/5/1999.