ksb0211
Guest
Okay, yet again I have come across a case that has me second guessing every decision I make. I'm hoping for some insight or suggestions.
Thanks.
Operative Report
This patient was seen as an emergency consultation.
REQUESTING PHYSICIAN
I was requested by Dr. XXXXXXXX to see this patient in the course of an urgent cesarean section.
INDICATIONS
The patient had had some adhesions between the uterus and some small bowel, which resulted in fenestration of the small bowel because of the dense adhesions.
DESCRIPTION OF PROCEDURE
I was called in, I assessed the situation and found that the bowel had probably, some portions of the small bowel had been torn. At this point, we came in freed up the loops or bowel, which were densely adhesed to the uterus and it was, perhaps, understandable how this fenestration had occurred in the course of an emergency delivery. I mobilized the small bowel, both proximally and distally, and after getting enough length free, I fired a GIA across the open surfaces, both proximally and distally and then resected the small bowel mesentery and handed off that specimen. Once we had cleaned up the area, we irrigated with about a liter of saline. I had augmented the patient's antibiotic coverage with Cefotan when I first entered the case. Once we had everything cleaned up, and had complete hemostasis, we opposed the antimesenteric portions of the bowel, with 3-0 silk, introduced the 75 mL GIA with green staples, fired it and then closed the resultant rent with a TA60 with green staples. We then closed the mesenteric rent with running suture of 2-0 Vicryl. The area of the bowel that we resected was probably in the order of, I would say, 15 cm or so. Once that was done, we replaced the bowel within the abdominal cavity, made sure that we had complete hemostasis, which we did, irrigated and at that point, Dr. XXXXX had turned her attention to closure. The patient tolerated my portion of the procedure without incident.
Thanks.
Operative Report
This patient was seen as an emergency consultation.
REQUESTING PHYSICIAN
I was requested by Dr. XXXXXXXX to see this patient in the course of an urgent cesarean section.
INDICATIONS
The patient had had some adhesions between the uterus and some small bowel, which resulted in fenestration of the small bowel because of the dense adhesions.
DESCRIPTION OF PROCEDURE
I was called in, I assessed the situation and found that the bowel had probably, some portions of the small bowel had been torn. At this point, we came in freed up the loops or bowel, which were densely adhesed to the uterus and it was, perhaps, understandable how this fenestration had occurred in the course of an emergency delivery. I mobilized the small bowel, both proximally and distally, and after getting enough length free, I fired a GIA across the open surfaces, both proximally and distally and then resected the small bowel mesentery and handed off that specimen. Once we had cleaned up the area, we irrigated with about a liter of saline. I had augmented the patient's antibiotic coverage with Cefotan when I first entered the case. Once we had everything cleaned up, and had complete hemostasis, we opposed the antimesenteric portions of the bowel, with 3-0 silk, introduced the 75 mL GIA with green staples, fired it and then closed the resultant rent with a TA60 with green staples. We then closed the mesenteric rent with running suture of 2-0 Vicryl. The area of the bowel that we resected was probably in the order of, I would say, 15 cm or so. Once that was done, we replaced the bowel within the abdominal cavity, made sure that we had complete hemostasis, which we did, irrigated and at that point, Dr. XXXXX had turned her attention to closure. The patient tolerated my portion of the procedure without incident.
