ER AUDIT

27/04/23
Thursday
SR ONCALL DR ALI KAMRAN
• REGISTRAR ON DUTY DR ZAMEER HUSSAIN
Debridement of Perianal area Necrotizing
Fascitis
• A 45/M, a case of poorly controlled DM, with history of Perianal swelling from one n half
week,, now presented with pain, discharge, foul smelling and blackening of that area
• O/E PR 96
1. There is discharging swelling at 7 o’clock and swelling with blackened area from 6-9
o’clock and foul smelling..discharge is pusy
2. TLC 15900, NEU 87%, HB 10.9
3. Patient was planned for EUA and proceed ..
4. On sigmoidoscopy and instilling the pypdine with H2O2, no apparent fistula was noted
and intact tone
5. On cruciate incison, there was necrotizing fascitis …debridement of the area done until
Healthy tissues reached and muscles without involvement of muscles..
Exp Laparotomy and Open Appendectomy
• A 60 years old female, a diabetic obese patient and having pain right
henia domen from last one week admitted through surgical ER from
last three days…
• O/E PR 92
• There was guarding of right hemi- abdomen and more in right lower
quadrant with BS positive
• TLCC 36000 , NEU 78 % AND HB 12
• Patient was planned for exp Laparotomy
• PEROP: 1- ONE LITRE pus 2-appendiceal mass
• Appendiceal perforation at base ….
• adhesions of greater omentum, ileum, and pelvic adnexa to the
cecum base ….adhenolysis done…Abdominal Cavity was washed with
normal saline
• purse string suture was taken around the base..after open
appendectomy

• Drain was Placed in Pelvis and wound closed in reverse order..