![]() ![]() ![]() |
| |||||
![]() ![]() ![]() ![]() |
A D V E R T I S E M E N T | |||||
Appendectomy Images |
![]() |
Mark-Up |
Description / Link to Frame |
Full Size |
![]() |
Appendix location beneath skin. |
||
![]() |
McBurney incision line. |
||
![]() |
Incision line relative to rectus abdominis. |
||
![]() |
Rocky-Davis transverse incision line. |
||
![]() |
Cecum and appendix relative to iliac fossa. |
||
![]() |
Direction of deepening the incision should be 45 degrees from vertical. |
||
![]() |
Vertical incision may end up outside the peritoneal reflection. |
||
![]() |
Skin incision. |
||
![]() |
Incision deepened to external oblique aponeurosis using electrocautery. |
||
![]() |
Nick is made in external oblique with knife. |
||
![]() |
External oblique opened using Mezzenbaum scissors. |
||
![]() |
External oblique edges retracted with McBurney or Roux retractors (not shown). |
||
![]() |
Fascia on surface of internal oblique is incised sharply in the line of the muscle fibers. |
||
![]() |
Two large blunt clamps (Pean) inserted perpendicular to each other. |
||
![]() |
Muscle fibers are spread down to the level of the transversus. |
||
![]() |
Two fingers used to gently spread internal oblique fibers. |
||
![]() |
Iliohypogastric nerve. |
||
![]() |
Transversus muscle split to expose preperitoneal fat and underlying peritoneum. |
||
![]() |
The peritoneum may show signs of inflammation. |
||
![]() |
Peritoneum is picked up and the resulting fold is pinched between two fingers. |
||
![]() |
Nick is made in peritoneal fold, and cultures taken of any fluid present. |
||
![]() |
Peritoneum opened a short distance in the line of incision. |
||
![]() |
Appendiceal artery. |
||
![]() |
Normal appendix. |
||
![]() |
Early appendicitis. |
||
![]() |
Suppurative appendicitis.. |
||
![]() |
Gangrenous appendicitis. |
||
![]() |
Perforated appendix. |
||
![]() |
Exploratory finger sweep from lateral parietal peritoneum under appendix toward medial side. |
||
![]() |
Mobilization of appendix by finger dissection. |
||
![]() |
Appendix bluntly separated from an adherent blanket of omentum. |
||
![]() |
Cecum gently lifted into wound by hooking a finger under a taenea. |
||
![]() |
Cecum broadly grasped with a moist sponge and gently rocked back and forth to deliver it and the attached appendix. |
||
![]() |
Mid portion of appendix sometimes tethered down by a band which must be cut to mobilize the appendix. |
||
![]() |
Retrocecal appendix. |
||
![]() |
If appendix is retrocecal and retroperitoneal, it is necessary to mobilize the cecum from the lateral peritoneal reflection. |
||
![]() |
Appendix mobilized into the wound and the base is visualized at its junction with the cecum. |
||
![]() |
Appendiceal mesentery is clamped. |
||
![]() |
Clamped appendiceal mesentery is ligated and divided from distal to proximal. |
||
![]() |
Appendix base milked distally and doubly ligated. |
||
![]() |
Appendix cut off flush with bottom of straight clamp using a knife blade. |
||
![]() |
If base is friable or gangrenous, it can be left open… |
||
![]() |
...and secured by inversion... |
||
![]() |
...and cecal purse string suture. |
||
![]() |
Appendix specimen. |
||
![]() |
Peritoneum closed with continuous absorbable 4-0 suture material. |
||
![]() |
Internal oblique closed by suturing fascia on its outer surface. |
||
![]() |
External oblique aponeurosis closed with continuous 4-0 absorbable suture. |
||
![]() |
Scarpa's fascia tacked together with three interrupted sutures. |
||
![]() |
Skin closed with staples if contamination has not been excessive. |
||
This page was last modified on 1/29/2000. A D V E R T I S E M E N T
|