karey
Networker
PROCEDURE PERFORMED: Exploratory laparotomy with jejunal resection with
an end jejunostomy and mucous fistula.
FINDINGS: Patient with large amount of free air upon opening abdomen
__________ appeared to be a mild amount of stool mixed in with
approximately 9+ L of ascites. Patient had extensive involvement of her
entire small bowel and small bowel mesentery with shortening of the
mesentery. There was previous end colostomy. There appeared to be
obstruction incorporating entire small bowel. It was impossible to
completely free up the loops of small bowel due to the advanced nature
of the cancer. We were able to identify perforation which appeared to
be at the mesenteric side of what appeared to be the mid jejunum. We
were unable to mobilize this piece of colon and ostomy was to be placed
in the right upper quadrant; however, due to the location of the
perforation, it was necessary to perform a resection of this area with
an end jejunostomy with a 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.
an end jejunostomy and mucous fistula.
FINDINGS: Patient with large amount of free air upon opening abdomen
__________ appeared to be a mild amount of stool mixed in with
approximately 9+ L of ascites. Patient had extensive involvement of her
entire small bowel and small bowel mesentery with shortening of the
mesentery. There was previous end colostomy. There appeared to be
obstruction incorporating entire small bowel. It was impossible to
completely free up the loops of small bowel due to the advanced nature
of the cancer. We were able to identify perforation which appeared to
be at the mesenteric side of what appeared to be the mid jejunum. We
were unable to mobilize this piece of colon and ostomy was to be placed
in the right upper quadrant; however, due to the location of the
perforation, it was necessary to perform a resection of this area with
an end jejunostomy with a 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.