surgical audit - จุฬาลงกรณ์มหาวิทยาลัย audit.pdf ·...
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Surgical auditDecember 2019
Summary
ConsultOPD
ConsultIPD
ConsultER/OPD 9
Refer
0 17 17 5
สก19 สก18 สก17 สก15G1 สก14 NICU SCU PICU3 10 1 5 12 5 2 2
Refer
Date Age HN WARD Dx Operation
02/12/62 1 m 116711/62 15G1ARM with Rectoperineal fistula s/p
anoplasty with gut obstructionDouble end colostomy
14/12/62 1 m 119975/62 15G1 Hirschsprung disease Full thickness rectal biopsy
16/12/62 2 y 120499/62 14 Ruptured choledochal cystExplore lap with cholecystostomy
with T tube placement
22/12/62 3 d 122391/62 15G1 Meconium ileus Explore lap with sigmoid biopsy with
Bishop-Koop ileostomy
23/12/62 1 y 122452/62 PICUSegmental bowel volvulus with
septic shock
Explore lap with small bowel resection with double end
jejunostomy with end to end ileoileal anastomosis
OR
Pediatric Surgery Operation IPD Daycare Emergency (สก) Emergency (ภมู)ิ36 30 7 1
Operation (others)Urology Craniofacial Pediatric Anaesthesiology Liver tran.
5 4 16 3 1
Emergency
Date Age HN WARD Dx Operation ORสก ORภูมิ
08/12/62 1 d 117571/62 SCU Anorectal malformation Double end colostomy
19/12/62 4 m 118868/62 14Biliary atresia with
anastomosis leakageRevision portojejunostomy
20/12/62 1 d 121646/62 NICU Meconium peritonitisExplore lap abdominal drainage with small bowel resection with
double end ileostomy
20/12/62 3 d 120959/62 NICU Total colonic aganglionosisExplore lap with serial biopsy
with double end ileostomy
23/12/62 1 y 122452/62 PICUSegmental bowel volvulus with
septic shock
Explore lap with small bowel resection with double end
jejunostomy with end to end ileoileal anastomosis
22/12/62 0 d 112326/62 NICUCongenital diaphragmatic
herniaTransabdominal diaphragmatic
hernia repair
25/12/62 1 y 89967/62 14 Perianal abscessI&D with Penrose drain
placement
25/12/62 41 d 123631/62 OPD Abscess left shoulder Aspiration
Consult
วนัที่ อายุ HN Ward Dx Consult for Operation Ward ER/O9 OPD
03/12/62 7 y 68641/56 15G2 Portal vein thrombosis Portosystemic shunt Advice
04/12/62 5 y 31623/57 14 Abdominal pain Appendicitis Admit observe
06/12/62 1 d 11757/62 SICU Anorectal malformation Proper management Colostomy
06/12/62 1 m 113920/62 6 Left mandible mass Proper management Observe
06/12/62 1 y 62324/61 18 เสา Tongue tie Release Release
07/12/62 4 y 63928/60 ER Mild head injury Proper management Discharge
07/12/62 7 y 84849/55 OPD9Phimosis s/p circumcision with
bleeding from surgical siteProper management Dressing
07/12/62 14 Mild head injury Proper management Admit observe
07/12/62 3 y 302357/59 OPD9 Short bowel s/p gastrostomy Gastrostomy leak Dressing
08/12/62 0 d 81327/62 NICU Bilat inguinal hernia Proper management Bilat herniotomy
10/12/62 1 y 47151/62 18 Intussusception Proper management Pneumatic reduction
11/12/62 4 m 118868/62 15 Choledochal cyst type 4a Proper management Lap assisted Kasai
13/12/62 10 y 25167/53 18 Abdominal pain Appendicitis Admit observe
13/12/62 13 d 117707/62 NICU Eventration of Rt diaphragm Proper management Diaphragmatic repair
13/12/62 4 y 18 เสา HD s/p ileostomy Closure ileostomy
15/12/62 1 d 120156/62 NICU Gastroschisis Silo placement Observe
Consult
วนัที่ อายุ HN Ward Dx Consult for Operation Ward ER/O9 OPD16/12/62 8 y 19654/55 14 Infected wound I&D I&D
17/12/62 7 y 3938/56 15g1Near total intestinal
aganglionosisIleal ulcer observe
17/12/62 1 y 67625/61 18 เสา Eventration Lt diaphragm s/p plication with vomiting
Proper management observe
17/12/62 11 y 44801/52 OPD9 Abscess right tibia I&D Advice
18/12/62 10 y 6571/52 ER Abdominal pain Appendicitis Discharge
18/12/62 ER Abdominal pain Appendicitis Observe
18/12/62 1 y 89967/62 ER Fecal impaction Proper management Admit and laxative
19/12/62 2 d 120959/62 SCU Total colonic aganglionosis Proper managementExplore lap with serial biopsy with
double end ileostomy
19/12/62 1 y 113789/61 14 Mild head injury Proper management Admit observe
20/12/62 1 d 121646/62 NICU Meconium peritonitis Proper managementExplore lap abdominal drainage with small bowel resection with
double end ileostomy
21/12/62 0 d 123050/62 NICU Duodenal atresia Proper management Duodenoduodenostomy
21/12/62 1 m 121412/62 15G1 IIH Proper management Herniotomy
22/12/62 0 d 122326/62 NICU CDH Proper management Repair
23/12/62 4 y 120435/62 17 R/O TB LN Proper management Excisional biopsy
24/12/62 13 y 123141/62 ER MHI Proper management Discharge
24/12/62 1 y 48189/61 18 Gastrostomy Proper management Change
25/12/62 40 d 123631/62 ER Cystic lesion Lt shoulder Proper management Aspiration
26/12/62 2 y 124011/62 18 LGIB Proper management Advices
27/12/62 6 y 56623/61 PICU Gut obstruction Proper management Conservative
28/12/62 13 y 110198/62 OPD9 Gut obstruction Proper management Conservative
Consult r/o appendicitis 4 เป็นจรงิ 0
Trauma 4
gut obstruction 2
Morbid and mortal conferenceDecember 2019
41989/60
• Thai boy age 4 years 3 months old
• Penoscrotal hypospadias
• First stage urethroplasty (3 years 3 months old)
• Investigation• 46,XY• Normal U/S KUB
41989/60
• Second stage urethroplasty• (29/11/62)
• Post-operative day 3• Pus from suture line
• Management• Ceftriaxone Tazocin
• Pus C/S E.coli
• Post-operative day14• D/C
89967/62
• Thai girl age 1 year 2 months old
• CC: Constipation 2 months PTA
• PI: Age 7 months old, constipation, no soiling, • Primary hospital suggest anal dilatation
• PH: No delay pass meconium
• PR: anal opening at posterior fourchette
anal ridge at anatomical anal opening
• IMP: ARM with perineum fistula
89967/62
• Barium enema (10/10/62; age 1 year old)• No obstruction or narrowing segment
• Ultrasonography of KUB (10/10/62; age 1 year old)• No demonstrable abnormality of the KUB system
• Operation• Relocation of anus 11/12/62
• Post operation day 5th
• Discharge
89967/62
• Post operation day 7th
• Cannot pass stool 1 day PTA• PR: impact feces, no anastomosis
stricture
• Treatment: lactulose 10 ml oral bid
• Post operation day 15th
• Pus from perianal 1 day PTA• PE: perianal abscess at 9 o’clock
• Treatment• I&D with Penrose drain placement
118868/62
• Thai boy, Age 4 months, 11 days old, 5763 grams
• G3
• Term
• male
• Body weight 3,110 grams
• Jaundice on photo 3 days
• Feeding S26 3 oz 8 – 10 feed/day
118868/62
• CC: jaundice 1 week PTA
• PI: 1 week PTA, low grade fever, abdominal distension, no vomiting, no diarrhea, jaundice• Primary hospital admit and treatment as sepsis
• Refer to KCMH
• PE: Liver 2 FB BRCM, liver span 8 cm, spleen 3 FB BRCM
• Lab: TB 14.38, DB 10.81, ALP 1113, GGT 1428
SGOT 354, SGPT 247, Alb 2.8, Glo 4.5, Pro 7.3
Hct 31.3, WBC 30320 (N58%), Plt 310000, INR 1.27
118868/62
• Ultrasonography of upper abdomen• Liver cirrhosis with suggested periportal fibrosis and small
intrahepatic bile cysts; likely from biliary atresia
• Cystic dilatation of the right hepatic duct and CBD; probably type 𝐼𝑉a choledochal cyst
• Evidence of portal hypertension
118868/62
• Laparoscopic assisted Kasai operation• 12/12/62; Age 134 days• Cyst lesion at CBD and atretic CHD
• Postoperative day 6• Penrose drain: 276 mL, dark yellow
• Revision of portoenterostomy• 19/12/62; post operative day 7• Leakage at posterolateral of anastomosis site
117571/62
• Birth day: Friday 6th December 2019, 10:13
• G1, Twin A, Maternal age 36 years old
• Gestational age 37 weeks
• Male
• APGAR 9, 10
• Body weight 3,046 grams
117571/62
• Distal sigmoid colostomy with mucous fistula
117571/62