NancyZ76
Contributor
PREOPERATIVE DIAGNOSIS:
Obstructing sigmoid colon cancer with secondary abdominal compartment syndrome.
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POSTOPERATIVE DIAGNOSIS:
Obstructing sigmoid colon cancer with secondary abdominal compartment syndrome.
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PROCEDURE:
Double-barrel transverse colostomy.
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HISTORY:
This is a 65-year-old male admitted early this morning with a bowel obstruction secondary to an obstruction from a distal sigmoid rectal cancer. The patient started to develop respiratory distress this morning and was admitted to the ICU. I was asked to consult. Examination revealed markedly distended abdomen. Review of the CAT scan showed marked distention of both small and large bowel. It was decided to proceed with surgery. Because the patient was not in stable condition, we decided to do the minimal amount of surgery necessary, which would be to construct a double-barrel transverse colostomy.
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DESCRIPTION OF PROCEDURE:
With the patient under satisfactory general anesthesia in a supine position on the operating room table, the patient's abdomen was prepped with ChloraPrep and draped in the usual manner. A small incision was made in the upper midline. Incision was carried down through subcutaneous tissue exposing the fascia. The fascia was divided and the peritoneum was divided exposing the colon. The colon was massively distended. It was able to be gently milked out of the incision. A bridge was placed behind it through the mesentery to keep it elevated. The colon was then opened with a large amount of air being expelled. The colostomy was matured with multiple interrupted sutures of 0 chromic. The bowel was slightly dusky, but it did appear to be viable. A bag was applied over it. A consideration was made of doing the exploratory laparotomy, but it was decided because of the patient's condition that we would try to decompress him for the next few hours, then I would do serial observations over the afternoon and evening to make sure that there was no decompensation of his condition indicating possible ischemic bowel. The patient tolerated the procedure well and was taken back to the ICU in stable condition.
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ESTIMATED BLOOD LOSS:
Less than 5 mL.
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COMPLICATIONS:
None.
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FINDINGS:
Massively dilated transverse colon.
Obstructing sigmoid colon cancer with secondary abdominal compartment syndrome.
*
POSTOPERATIVE DIAGNOSIS:
Obstructing sigmoid colon cancer with secondary abdominal compartment syndrome.
*
PROCEDURE:
Double-barrel transverse colostomy.
*
*
HISTORY:
This is a 65-year-old male admitted early this morning with a bowel obstruction secondary to an obstruction from a distal sigmoid rectal cancer. The patient started to develop respiratory distress this morning and was admitted to the ICU. I was asked to consult. Examination revealed markedly distended abdomen. Review of the CAT scan showed marked distention of both small and large bowel. It was decided to proceed with surgery. Because the patient was not in stable condition, we decided to do the minimal amount of surgery necessary, which would be to construct a double-barrel transverse colostomy.
*
DESCRIPTION OF PROCEDURE:
With the patient under satisfactory general anesthesia in a supine position on the operating room table, the patient's abdomen was prepped with ChloraPrep and draped in the usual manner. A small incision was made in the upper midline. Incision was carried down through subcutaneous tissue exposing the fascia. The fascia was divided and the peritoneum was divided exposing the colon. The colon was massively distended. It was able to be gently milked out of the incision. A bridge was placed behind it through the mesentery to keep it elevated. The colon was then opened with a large amount of air being expelled. The colostomy was matured with multiple interrupted sutures of 0 chromic. The bowel was slightly dusky, but it did appear to be viable. A bag was applied over it. A consideration was made of doing the exploratory laparotomy, but it was decided because of the patient's condition that we would try to decompress him for the next few hours, then I would do serial observations over the afternoon and evening to make sure that there was no decompensation of his condition indicating possible ischemic bowel. The patient tolerated the procedure well and was taken back to the ICU in stable condition.
*
ESTIMATED BLOOD LOSS:
Less than 5 mL.
*
COMPLICATIONS:
None.
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FINDINGS:
Massively dilated transverse colon.
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