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2435 FOREST DRIVE COLUMBIA, SC 29204 (803)256-5300 DISCHARGE SUMMARY
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cc: Dr. Roper Gaddy | PATIENT: James W. Green Jr. Please see typed admission note for history of present illness and physical examination. COURSE IN THE HOSPITAL: Mr. Green was admitted with a known abdominal mass. On the day of admission he was started on bowel prep. The following day he went to the operating room and underwent resection of a gastrointestinal stromal tumor of the proximal jejunum along with the mesentery. He had evacuation of associated hematomas and removal of two small metastases through the omentum and to the mesentery. No gross tumor remained. Postoperatively he did quite well, especially the first couple of days. However, he then became a little confused and he was complaining bitterly of abdominal pain. I examined him, as did two of my associates, and we could find no evidence of abdominal catastrophy. We continued supportive care. We place a nasogastric tube that only drained about 200 cc. This was removed by the patient and was replaced several times. He became progressively confused ... He was started on high dose Librium. He was then able to rest and once he woke up he was doing somewhat better. This took several days. We worked with him on walking. He remained relatively strong and was able to walk. Over the ensuing days he gradually improved his diet. All staples were removed from his incision. He did have a low potassium, down to 3.0, but this was supplemented. On 1/8/01 he was discharged. Followup was arranged with me. His final diagnosis was gastrointestinal stromal tumor which is metastatic. Upon discharge we arranged not only followup with me but also with Dr. McElveen or associate. The patient did appear somewhat depressed, as if in a mild depression. I talked to the patient's son about arranging an appointment for him to see Dr. Gaddy if that persists even after he goes home as it may be that he would be one I appropriate for some intervention such as a medication. I will plan to see him back in about a week or two.
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| 01/07/01 22:27 FAX 8032565512 | | 02
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OPERATIVE SUMMARY
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CC: Dr. Roger Gaddy | PATIENT: Jamem W. Green Jr. DATE OF OPERATION: 12/26/00 NAME OF OPERATION, Partial resection og proximal jejunum for malignant tumor (gastrointestinal stromal tumor) and resection of two small metastatic tumors, one in the omentum and one on the small bowel mesentery. SURGEON: J. Benjamin Tribble, M.D. ASSISTANT: None. ANESTHESIA: General. PREOPERATIVE DIAGNOSIS: Intra-abdominal mass. POSTOPERATIVE DIAGNOSIS: Gastrointestinal stromal tumor involving proximal jejunum with two identifiable metastases. DESCRIPTION OF PROCEDURE: The patient's abdomen was prepped with Betadine and draped in a sterile manner. A vertical incision was made in the midline and was carried both above and below the umbilicus. On exploration of the abdominal cavity I found that there was a mass in the left mid abdomen. There was also blood in the preperitoneal space. This was really bloody fluid as opposed to pure blood. On dissecting the area of the mass I gound that several loops of the small bowel were stuck to it but would free up fairly easily with blunt dissection. Part of the mace effect was created by hematoma in this region which created considerable inflammation. I got into two different hematomas and was able to aspirate the semisolid material fairly well. Eventually I was able to run the small bowel from the ligament of Treitz to ileocecal valve. It was in the proximal jejunum that there was a definite tumor mass on the antimesenteric border of the small intestine with apparently no tendencies to cause obstruction. However, it was a quite large mass, about the size of a baseball, and had mostly a smooth surface Run: 12/28/00-08:52 by HOLDERBAUM, KRISTI A
OPERATIVE SUMMARY - Department's copy
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OPERATIVE SUMMARY
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and in some placed it appears to have had hemorrhage into it and where
adhesions were stuck to it it bled very easily and in fact copiously.
It apparently was a vascular mass. | I did identify two other small implants, one on the omentum and one on another section of small bowel mesentery. Both of these were resected easily and sent for examination. One of them was examined by frozen section and proved to be a gastrointestinal stromal tumor. The larger mass was resected by dividing the jejunum with a GIA in two locations, both proximal and distal to the mass, getting margins of several centimeters. I then resected through the small bowel mesentery, using cautery on the peritoneal surface and then identifying the vessels and clamping them, cutting them, and tying with 2-0 silk and sometimes 2-0 silk suture ligatures. The wedge of omentum which contained a mass along with the segment of jejunum was removed from the field and sent for pathology and frozen section confirmation. Frozen section confirmation did identify this as a gastrointestinal stromal tumor. The area was irrigated and aspirated. The anastomosis of the two ends of the small bowel was accomplished with a functional end-to-end anastomosis using two applications of a TLC stapler. This anastomosis was reinforced with multiple 3-0 silk. The mesenteric defect was closed with interrupted 3-0 silks. The area was irrigated copiously to remove blood stained fluid. When the irrigant was coming back clear I then proceeded to close with running #1 PDS in the fascia followed by staples in the skin. Prior to skin closure I did irrigate the subcutaneous space. Sterile dressings were applied. The patient tolerated the operation well. There was some blood loss during the operation with oozing associated with blunt dissection of the tumor and because of a low hemoglobin to start with we did give him one unit of blood during the surgery. There was really no good option but to bluntly dissect around this tumor because multiple loops of small intestine were involved with the inflammatory process created by the bleeding that had occurred in that area. Presumably the bleeding had come from this tumor. At the time of completion of the operation all gross disease was removed but the fact that two metastases were identified suggests that microscopic disease is likely still present.
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The url of this page is
http://Genealogy.Org/~green/Green/surgrpt.htm and
http://millennium.FortuneCity.Com/byker/362/Green/surgrpt.htm
(
http://members.FortuneCity.Com/jgreen/Green/surgrpt.htm)
This page was put on the web 14 January 2001.
This page was Last Updated __.
This page was put on the web by
James W. Green III.