kelsmith4471
Contributor
SURGEONS NARRATIVE:
The patient in OR, placed in supine position. Once anesthesia with mask, ventilation was achieved.
She was placed in lithotomy position. The perineum was prepped and draped in usual sterile
fashion. We began the procedure by performing a sigmoidoscopy of her pouch, which demonstrated a
very nice healthy pouch. We entered the small bowel without difficulty. We then examined the
posterior aspect of her anastomosis because that is where appeared to be on the Gastrografin enema.
I was able to find a tract that we easily were able to the insert our probe into them. We
carefully opened this up a bit more to marsupialize it and then used a GIA stapler to marsupialize
it a bit more opening up about an inch of this area, so that we could easily place a drain up. I
notice when
we first placed a drain through this area. I first placed a forceps through this area. She began
to extrude a bit of green stool contents. I was not quite sure where this was coming from but it
continued to come from this area. I am concerned that we somehow created a bit of a fistula between the 2 areas. For this reason, I did place a
Mallinckrodt. We did actually scoped this area and I really could not appreciate any other bowel
anywhere but because of this concern, I am going to obtain a contrast study, CT scan today. The
patient tolerated the procedure well, and we will plan hopefully for ostomy taken down next week.
The patient in OR, placed in supine position. Once anesthesia with mask, ventilation was achieved.
She was placed in lithotomy position. The perineum was prepped and draped in usual sterile
fashion. We began the procedure by performing a sigmoidoscopy of her pouch, which demonstrated a
very nice healthy pouch. We entered the small bowel without difficulty. We then examined the
posterior aspect of her anastomosis because that is where appeared to be on the Gastrografin enema.
I was able to find a tract that we easily were able to the insert our probe into them. We
carefully opened this up a bit more to marsupialize it and then used a GIA stapler to marsupialize
it a bit more opening up about an inch of this area, so that we could easily place a drain up. I
notice when
we first placed a drain through this area. I first placed a forceps through this area. She began
to extrude a bit of green stool contents. I was not quite sure where this was coming from but it
continued to come from this area. I am concerned that we somehow created a bit of a fistula between the 2 areas. For this reason, I did place a
Mallinckrodt. We did actually scoped this area and I really could not appreciate any other bowel
anywhere but because of this concern, I am going to obtain a contrast study, CT scan today. The
patient tolerated the procedure well, and we will plan hopefully for ostomy taken down next week.