SUMMARY: Here after
evaluation it was felt that because there was not a clear-cut mass in the head
of the pancreas, therefore endoscopic ultrasound was done which revealed a 1.9 cm mass of the head of the pancreas. The vessels
appeared to be free. Because the endoscopic ultrasound and CT scan did not show
any vessel involvement or distant metastases, the patient was felt to be a
candidate for a Whipple procedure. He was told of the complications of the
procedure including bleeding, infection, anastomotic leak and a 2-5% mortality
and agreed.
HOSPITAL COURSE: The patient had bowel prep 1 day prior to surgery. He
underwent a Whipple procedure, with
estimated blood loss of 1 liter. The patient tolerated the procedure well and was extubated in the OR and transferred to the recovery room. Postoperatively
the patient's pain was controlled with an epidural catheter. The patient was on the ....... Study. The patient had borderline urine output immediately
postoperatively which responded to a combination of Lasix and fluid boluses.
On postoperative day 3, Swan-Ganz catheter and Cordis were discontinued. The patient was found to have a positive UA on postoperative day 3. For this he
was treated with ceftriaxone IV.
On postoperative day 4, the patient still had large NG output, and the decision was made not to discontinue the NG tube.
On postoperative day 5, the patient's NG was discontinued. The patient tolerated this well without nausea or vomiting.
Of note is that in the hospital the patient's epidural was discontinued on postoperative day 4, with no adverse effect.
On postoperative day 6, the patient had bowel movement and flatus and was started on all p.o. medications and started on a clear liquid diet and advanced
to general. The patient was having no difficulties with diet and was ambulating with the
assistance of physical therapy.
On postoperative day 8, the patient began to develop some diarrhea, which continued overnight to postoperative day 9. On postoperative day 9, the
decision was made to start Pancreas and to discharge the patient to home.
Operative report