Ex Lap

One of the most educational surgeries I've seen has been the exploratory laparotomy. This was done for the gunshot wound when I was on call (described in an earlier blog). Since there were multiple bullet wounds in the abdomen and back, we had to open up the abdominal cavity to look for bowel and solid organ injury. It was crazy. The surgeons did a large incision from the xiphoid process (bottom of sterum or breastbone) all the way to the pubis and opened up the belly like a cadaveric dissection. The surgeons "ran the bowel," looking in the small intestines for perforations. They dissected the large intestines away from the back wall of the abdomen (making it a peritoneal rather than a retroperitoneal structure) and looked at the stomach, pancreas, duodenum, kidneys, liver, and gallbladder. We found several bullets in the abdominal cavity and some bleeding, but otherwise it wasn't terribly bad. The entire procedure, which went from 2am-6:30am, was a beautiful teaching case in anatomy. I got asked ("pimped") a lot about nerves, blood supplies, anatomical landmarks, etc. but I learned a whole lot seeing everything in situ.