# 44140 44139  44626  ?



## cynthiabrown (Sep 4, 2012)

FINDINGS:  Patient who had had a previous perforated small bowel with
peritonitis and a very extensive operative experience with significant
problems of recovery, now presented after six months with improvement in
nutritional status for ileostomy closure.  She had been having trouble with
an enterocutaneous fistula and a previous ileocolonic anastomosis, as well
as bloody stools and chronic anemia.  She was brought to surgery for closure
of the ileostomy, excision of the enterocutaneous fistula and during the
procedure which was extensive, we had significant adhesions to lyse.  We
identified our ends of bowel. We identified normal colon. We also identified
a very dilated transverse colon up to the sigmoid flexure and a mass at this
location consistent with a cancer.  We resected the entire transverse colon
and the enterocutaneous fistula.  During resection the ileocolonic
anastomosis was widely open and draining into the abdomen some feculent
material.  This was all removed easily.  We removed the involved segments of
bowel and then proceeded with closure of the ileostomy with a small bowel to
small bowel anastomosis done in a stapled side-to-side fashion and a small
bowel to descending colon anastomosis done in a stapled side-to-side
fashion.  Overall we had a length of bowel over 200 cm in total length and
the patient was in satisfactory condition from that


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