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