Explor Lap, resection of small bowel, hernia repair


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1. Exploratiory Laparotomy
2. Resection of necrotic small bowel
3. Primary hernia repair

A transverse incision was made across the upper portion of protuberance in order to avoid previous incision site of umbilical hernia repair. Significant amount of ascites appeared under pressure shifted out. Within hernia sac appeared a second firm indurated mass. Furhter eval noted a segment approx 20 cm long, of black gangrenous bowel.

The bowel was traced both proximally and distally. Aprox 15cm proximal to the nectotic bowel, there was bluish mass in the wall of the small bowel that appeared to be bruised and possibly increasing gangrene. This was judged to be the necrotic proximal end of the planned resection and the pink bowel just distant to the necrotic area was chosen as the distal point. A side to side stapled anastomosis was then formed using a linear, cutting stapler. Bowel was then again dissected using a linear c utting stapler, leaving the anastomosis segment. Teh mesentery was then divided using the ligasure device. The mesentery appeared homostatic and the fascia anastomosis was then reduced into the abdomen. Eval of the addominal wall appeared a second amall hernia in the abdom wall, lateral to what was the previous repair site. Decision was made not to open this second hernia further but rather sew the hernia defect of the abdominal was using figure 8 vicryl sutures....

Sorry for the typos :)