Creation of end jejunostomy and mucous fistula


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PREOPERATIVE DIAGNOSIS: Perforated NEC, s/p resection and abdominal closure



1. Exploratory laparotomy with small bowel resection

2. Creation of end jejunostomy and mucous fistula

ANESTHESIA: General, endotracheal intubation


COUNTS: Sponge and needle count correct x2.

INDICATIONS: This is a 10.5 days male child referred for reexploration - under surgery by DOCS for perforated NEC (with mutliple holes). Had small bowel resection and was left in discontinuity. The risks and benefits of operation were discussed with the family. Complications including bleeding, infection, recurrence, and damage to nearby structures were discussed with the family. The families' questions were completed answered. The family understood and asked us to proceed.

FINDINGS: Bowel viable, leaking enterotomy in proximal segment approximately 15 cm from LOT - resected and end jejunostomy and mucous fistula created in transverse incision.

SPECIMENS: Small bowel


TECHNIQUE: After the patient was brought to the OR, the child was placed in supine position. General anesthesia was induced and ETT accomplished. .

A time out was performed per protocol. The patient was identified by his name band and his medical record number and date of birth were used as confirmation. The consent form was reviewed. The identification on the consent form and the nature of the proceedure was verified. Laterality, patient position and the availability of equipment was reviewed. The need for antibiotics and thromboprophylaxis was discussed. Impax was reviewed for applicable imaging. We reviewed the patient's allergies. Readiness was confirmed with the anesthesiologist, the circulator and the scrub technician.

The abdomen was then prepped and draped in the usual fashion. The right upper quadrant transverse incision was opened. The bowel was eviscerated and the anatomy identified - the majority of the bowel was viable, with the distal resection area intact. There was a leaking small enterotomy in the proximal bowel 15 cm from LOT. This area was resected. The jejunum was removed with the aid of harmonic scalpel. The abdomen was irrigated. The proximal and distal ends of the jejunum were then brought through the extremes of the transverse incision (jejunostomy on patients left, mucous fistula on patient's right), with care taken to not twist the bowel, and provide enough extraabdominal bowel to create an adequate stoma.

The abdomen was then closed with 3-0 Vicryl in the fascia and 5-0 Monocry in the skin. Sterile dressing was placed on midline incision and stoma bag on the stoma.

The child was taken NICU in stable condition.