Ligation of branch of superior epigastric artery ?

bill2doc

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PROCEDURES PERFORMED:
1. Exploratory laparoscopy.
2. Conversion to an open procedure with open laparotomy.
3. Ligation of branch of superior epigastric artery.

A curvilinear infraumbilical incision was then made and carried through the fat and fascia to the base of the umbilical stalk which was then grasped and elevated. A fascial incision was then made at the base of the umbilicus. Heavy suture was placed on either side of this fascial defect and the Hasson port was then advanced. Pneumoperitoneum was then established. The camera was introduced. Of note, there was a significant amount of blood noted intraabdominally as well as a large hole in the anterior abdominal wall. Given the amount of blood decision was made to convert to an open procedure.

A midline incision from his previous operation was then followed both superiorly and inferiorly. The abdomen was then packed in all four quadrants. The packing was then removed and we did a systematic exploration of the abdomen. Right upper quadrant was a laceration of the abdominal wall that extended through the capsule of the liver. The liver portion appeared to be hemostatic. However, there was acute bleeding from the abdominal wall that appeared to be arterial. This was clamped and suture ligated. The abdominal wall defect was then closed. The bowel was then run from the ligament of Treitz to the ileocecal valve; no injury to the bowel was noted. The colon was then examined from the cecum to the splenic flexure and there was no evidence of injury to the colon. The laceration of the liver appeared to be stable and did not go all the way through to the other side of the capsule. The gallbladder was intact. The abdomen was then copiously irrigated with sterile normal saline. Hemostasis was then maintained. The abdomen was then closed and the skin was closed with staples. Outside wound was then copiously irrigated with saline.
 
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