herrera4
Guru
this patient had a colectomy 2 wks prior-im thinking this is more than just a colostomy code
thanks
.......... There were some adhesions from small bowel to the area of the anastomosis and these were carefully taken down. In the region just above the anastomosis there was ischemic and dead-appearing colon. The anastomosis was felt to be intact but adjacent to the left sidewall of the pelvis the colon looked completely necrotic and appeared to be a source of the pelvic abscess. This was taken down bluntly. The anastomosis was bluntly disrupted which was not difficult given the ischemic nature of the colon. The proximal colon was clamped closed. This was of questionable viability. There was quite a bit of fecal spillage at this point. This was generously irrigated and suctioned free. The distal portion of the colon in the region of the anastomosis was examined. The existing silk stitches were removed. There was quite a bit of backflow from stool in the colon. This was generously irrigated and suctioned free. A running 2-0 Vicryl stitch was used to oversew the rectal stump. This was reinforced with an additional 2-0 figure-of-eight Vicryl stitch because of the non-viable edges continuing to leak. The corners of the rectal stump were marked with 3-0 blue nylon stitch. The area was generously irrigated and suctioned free. A 10-mm Jackson-Pratt drain was left in this area and exited the right lower quadrant. There was no significant bleeding noted. The small bowel that was within the pelvis that was sharply taken down was observed. One portion of this small bowel had quite a bit of debris associated with it. It was uncertain if this was colonic wall or abscess cavity. Nonetheless it was felt that this should be left in place rather than do small bowel resection because the integrity of the small bowel appeared to be intact. The end of the colon was somewhat shortened for an end colostomy. An additional portion of the mesocolon was divided in order to give more length. A left mid abdomen colostomy site was planned. A circular incision was made through the skin. The anterior rectus fascia was divided in a cruciate incision. The rectus muscle was split and the posterior rectus fascia was opened. The end of the colon was brought through the colostomy site with some difficulty but it was brought completely up. The lateral side of the colon was somewhat compromised although intact. The medial side was more bulky with quite a bit of inflammatory tissue which resulted in an asymmetrical stoma. With the stoma in place the abdomen was re-explored. The abdomen was generously irrigated and suctioned free. The abdomen was closed with running looped #1 PDS. The skin was closed with staples. The colostomy was matured as best as possible. The edges and end of the colon were tacked to the dermis layer with numerous 3-0 Vicryl stitches. The edges could not be everted because of the extensive inflammation of the area. The stoma appeared viable. The lumen was well visualized and inserting a Yankauer suction into the lumen yielded fecal material. The stoma appliance was placed. The dressing was placed. The abdomen was intact. The patient was brought to the Recovery Room intubated. He was eventually transferred to the Intensive Care Unit intubated.
thanks again for help
thanks
.......... There were some adhesions from small bowel to the area of the anastomosis and these were carefully taken down. In the region just above the anastomosis there was ischemic and dead-appearing colon. The anastomosis was felt to be intact but adjacent to the left sidewall of the pelvis the colon looked completely necrotic and appeared to be a source of the pelvic abscess. This was taken down bluntly. The anastomosis was bluntly disrupted which was not difficult given the ischemic nature of the colon. The proximal colon was clamped closed. This was of questionable viability. There was quite a bit of fecal spillage at this point. This was generously irrigated and suctioned free. The distal portion of the colon in the region of the anastomosis was examined. The existing silk stitches were removed. There was quite a bit of backflow from stool in the colon. This was generously irrigated and suctioned free. A running 2-0 Vicryl stitch was used to oversew the rectal stump. This was reinforced with an additional 2-0 figure-of-eight Vicryl stitch because of the non-viable edges continuing to leak. The corners of the rectal stump were marked with 3-0 blue nylon stitch. The area was generously irrigated and suctioned free. A 10-mm Jackson-Pratt drain was left in this area and exited the right lower quadrant. There was no significant bleeding noted. The small bowel that was within the pelvis that was sharply taken down was observed. One portion of this small bowel had quite a bit of debris associated with it. It was uncertain if this was colonic wall or abscess cavity. Nonetheless it was felt that this should be left in place rather than do small bowel resection because the integrity of the small bowel appeared to be intact. The end of the colon was somewhat shortened for an end colostomy. An additional portion of the mesocolon was divided in order to give more length. A left mid abdomen colostomy site was planned. A circular incision was made through the skin. The anterior rectus fascia was divided in a cruciate incision. The rectus muscle was split and the posterior rectus fascia was opened. The end of the colon was brought through the colostomy site with some difficulty but it was brought completely up. The lateral side of the colon was somewhat compromised although intact. The medial side was more bulky with quite a bit of inflammatory tissue which resulted in an asymmetrical stoma. With the stoma in place the abdomen was re-explored. The abdomen was generously irrigated and suctioned free. The abdomen was closed with running looped #1 PDS. The skin was closed with staples. The colostomy was matured as best as possible. The edges and end of the colon were tacked to the dermis layer with numerous 3-0 Vicryl stitches. The edges could not be everted because of the extensive inflammation of the area. The stoma appeared viable. The lumen was well visualized and inserting a Yankauer suction into the lumen yielded fecal material. The stoma appliance was placed. The dressing was placed. The abdomen was intact. The patient was brought to the Recovery Room intubated. He was eventually transferred to the Intensive Care Unit intubated.
thanks again for help