PREOPERATIVE DIAGNOSIS: Right lower quadrant pain.
POSTOPERATIVE DIAGNOSIS: Right lower quadrant pain..
TITLE OF OPERATION: Laparoscopy with pain mapping.
ANESTHESIA: Local with sedation.
NDICATIONS: The patient is a 50-year-old woman who has had recurrent attacks of right lower quadrant pain. She has had multiple abdominal procedures and presents now for pain mapping as the source of her pain has eluded non invasive imaging. Findings included maximal tenderness with manipulation of the left greater than right round ligament. No evidence of hernia. No evidence of adhesions.

PROCEDURE: The patient was brought to the Operating Room and placed in the supine position. Following intravenous sedation the patient was prepped and draped in the usual sterile manner using ChloraPrep. After infiltration of local anesthetic a small incision was made within the umbilicus. This was carried down through skin and subcutaneous tissue. The fascia was incised sharply and the fascial edges were elevated and after additional of local a 5 mm port was inserted. Pneumoperitoneum was then established with the pressure of 8 mmHg. An additional port was placed in the suprapubic region after infiltration of local anesthetic. The patient's anesthetic was then lightened and consciousness came back. The patient seemed to be somewhat hypersensitive globally. There was no evidence of adhesions intraabdominally. There was mild tenderness with pain to palpation of the previously marked point of maximal tenderness in the right lower quadrant. She had exquisite tenderness with manipulation of the round ligaments bilaterally with the left being more sensitive than the right. The patient was queried during the procedure and she felt that knee pain was reproduced with manipulation of her round ligaments. Further inspection of her adnexa and uterus did expose large uterus with some congestion of all the vessels. The procedure was terminated. Pneumoperitoneum was evacuated and the wounds were closed with Vicryl sutures. The patient tolerated the procedure well and was brought back to the Recovery Room in stable condition.
The plan is for follow up with her gynecologist. Feel that hysterectomy would likely be beneficial in ameliorating her pain.