Caution: This post shares detailed
information about Bob's second (emergency) surgery. No pictures, but
lots of descriptions. If you think reading this will make you uncomfortable, you might want to pass on this post. =)
Emergency Surgery
6pm: Bob is now stable enough to go
down to the OR. His surgeon advises me (Angela) that Bob's condition
is a "life threatening situation". He is septic (infection
has moved from his abdominal cavity to his blood stream and will
eventually infect all organ systems in the body without intervention)
and also at high risk due to his cardiac history. He will be opening
Bob's abdomen with a very large incision, and is unsure of what he
will find or what exactly will be done.
8pm: Bob has come out of the surgery
and in ICU recovery. The surgery entailed a lot of work. Basically,
there was a pinhole leak in the joint where the small intestine and
the large intestine were joined together after the first 1/3 of
Bob's large intestine was removed in Monday's surgery. This leak
likely didn't happen until sometime Tuesday, and it was tiny enough
that the full effect of the leaking wasn't apparent until Wed
afternoon.
The surgeon completely washed out
Bob's abdomen. He then detached the intestines where they had been
stapled together, and removed three more inches of small intestine
from one end and three more inches of large intestine from the other
end. He didn't re-join the intestine ends, but instead stapled them
off completely from one another.
Since the infection had not yet
responded to antibiotics (too soon), the surgeon didn't close up
Bob's abdomen. Instead, he packed it with a sponge that is connected
to a vacuumed wound-vac, which will draw fluids out of his abdomen
for the next 48 hours. Depending on how soon the infection gets under
control and when Bob's vitals are stable, the surgeon will then go
back in and do a followup surgery.
This next following operation will be to again
wash out the abdominal cavity, and possibly to also re-join the two
intestine ends, depending on the condition of everything. He may also
close up the muscle layer of the abdomen, but will likely wait to
close the fascia and skin until another 48 hours passes. That will
require another (and hopefully the last) surgery to accomplish. That
will mean between Mon, 11/20 and Mon, 11/27, Bob will have had four
surgeries in total.
Concerns
This surgery was done under the worst
of possible scenarios, since there was an active septic infection.
The next day or two will be a struggle to balance Bob's vitals. He
came back from the surgery on a ventilator (breathing tube down into
his lungs), a central line in his neck with eight IV ports, an
arterial line in his left arm, a bladder catheter, an NG tube through
his nose into his stomach, a vacuum drain on the sponge over his open
abdomen, two additional veinous IV's (one in the back of each hand),
anti-clotting pressure cuffs filling on each calf, EKG and heart
monitors, an internal temperature sensor, and pulse oximeters on his
earlobe and fingertip.
After his first 24 hours in the ICU
post surgery, I'll update his vitals and his progress. Goal is to
have him stable enough to tolerate the next surgery, which is
tentatively going to be on Saturday (in 48 hours).
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