karey
Networker
PROCEDURE PERFORMED: Exploratory laparotomy with jejunal resection withan end jejunostomy and mucous fistula.
After timeout procedure was performed, we made a vertical skin incision.
A large amount of free air was indeed discovered and over 9 L of ascites
was evacuated. We explored the entire abdomen and see above
description. We attempted to deliver a loop of small bowel through a
right ostomy site. This was performed by grasping the skin, excising
__________ area and dissecting down to the underlying fascia. A
cruciate incision was made in the fascia and the underlying rectus
muscles were separated. We delivered the loop of bowel which appeared
to be mid jejunum through the ostomy site. Due to the location of the
perforation, I felt that the only safe option would be to perform an end
jejunostomy with a mucous fistula as most likely the patient would
become obstructed downstream. We then divided the area of perforation
with the GIA stapler 80 green and resected out the area of perforation.
An end jejunostomy was then performed by opening on the staple line,
everting the edges and a series of 2-0 Dexon were used to secure the
ostomy to the dermis. On the distal limb, an area was created along the
staple line. This was approximately 0.5 cm area for mucous fistula and
this was secured to the skin edges in __________ everted fashion. It is
important to note that the fascia was closed prior to the maturity of
the ostomy with looped #1 Maxon x2. There was incorrect count, missing
a pair of scissors, and so an x-ray was obtained, 2 views. In
discussion with the radiologist, there was clearly no foreign body
within the abdomen except for the 4 drains which were placed prior to
the closure of the abdomen, which were 19-French Bard drains. There was
1 placed within the pelvis, 1 placed along each of the paracolic gutters
and 1 in the right upper quadrant. The patient taken to ICU in critical
condition.