Surgical audit - จุฬาลงกรณ์มหาวิทยาลัย audit.pdf ·...

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