ksb0211
Guest
A bit frustrated with this one. Any input would be appreciated....
The patient was brought to the operating room. After attainment of sufficient general anesthesia, she was pretreated with antibiotics and prepped and draped in the usual sterile fashion. We sewed off the movement of this stoma adn then, we took down the colostomy and our plan is going to be to just sort of mobilize this and try to get this resolved. When we started to do this, it was probably about 25 cm piece of colon that was inspissated with stool, really did not look very good, it was all extra abdominal. We took this downto the fascia and really had a hard time defining what was what. We made a midline incision at that point and we entered the abdominal cavity by using a 2 hand technique, we were able to define the internal aspects of the stoma and get that all reduced, mobilized the transverse colon and fired a stapler across this distal area of markedly distended colon that was impacted with stool. Once that was done, we took down the mesocolon using 2-0 silk ties and then we had a nice clean looking transverse colon, it was quite viable. We opened the abdominal cavity a bit more, there was a previous ostomy site down the left lower quadrant, which the other hernia was and we closed that defect with 2 figure of eight sutures of #1 Prolene. They were placed in a mattress in a figure of eight fashion. Once that was done, we came back up to the colostomy, matured it on the table, we probably used 15 or 20, 2-0 silks to fix the existing fascia to the sidewall of the colon to try to forestall hernia and then went in from _________ position and put further sutures on the internal aspect again to try to forestall hernia formation. Once that was done, we irrigated, aspirated and closed the midline wound with a double-stranded #1 PDS. Then placed Ancef powder and then some very widely spaced staples. At this point, we then covered that with the sterile dressing and then matured the colostomy of the table. Using 2-0 Vicryl from, the skin to the side of the colostomy then up to the edges and everted it. At that pooint, sterile dressing was applied. The patient actually tolerated the procedure quite well.
The patient was brought to the operating room. After attainment of sufficient general anesthesia, she was pretreated with antibiotics and prepped and draped in the usual sterile fashion. We sewed off the movement of this stoma adn then, we took down the colostomy and our plan is going to be to just sort of mobilize this and try to get this resolved. When we started to do this, it was probably about 25 cm piece of colon that was inspissated with stool, really did not look very good, it was all extra abdominal. We took this downto the fascia and really had a hard time defining what was what. We made a midline incision at that point and we entered the abdominal cavity by using a 2 hand technique, we were able to define the internal aspects of the stoma and get that all reduced, mobilized the transverse colon and fired a stapler across this distal area of markedly distended colon that was impacted with stool. Once that was done, we took down the mesocolon using 2-0 silk ties and then we had a nice clean looking transverse colon, it was quite viable. We opened the abdominal cavity a bit more, there was a previous ostomy site down the left lower quadrant, which the other hernia was and we closed that defect with 2 figure of eight sutures of #1 Prolene. They were placed in a mattress in a figure of eight fashion. Once that was done, we came back up to the colostomy, matured it on the table, we probably used 15 or 20, 2-0 silks to fix the existing fascia to the sidewall of the colon to try to forestall hernia and then went in from _________ position and put further sutures on the internal aspect again to try to forestall hernia formation. Once that was done, we irrigated, aspirated and closed the midline wound with a double-stranded #1 PDS. Then placed Ancef powder and then some very widely spaced staples. At this point, we then covered that with the sterile dressing and then matured the colostomy of the table. Using 2-0 Vicryl from, the skin to the side of the colostomy then up to the edges and everted it. At that pooint, sterile dressing was applied. The patient actually tolerated the procedure quite well.