Michele1229
Networker
Hello everyone.
We were hoping someone would have some suggestions on this procedure. The doc was unsure as well.
The patient was having bleeding and no one could figure out where it was coming from. Our guy went in to see if he could find it.
Post Op Dx: Marginal Ulcer
Procedure: Exploratory Laparotomy, Oversew of Marginal Ulcer of Hepaticojejunostomy Anastomatic Site
A midline supraumbilical incision was made through which sharp and blunt dissection was carried to the abdominal cavity. Of note, was a large incisional hernia with essential loss of domain. With care taken to avoid injury to the small bowel or colon, meticulous dissection was carried down through a thick layer of fibrotic tissue until I was ultimately within the abdominal cavity. Omental adnesions were taken down and I was able to identify the transverse colon. This was mobilized exposing the jejunal limb of her hepaticojejunostomy. Initial inspection was not consistant with intraluminal hemorrhage. I mobilized to the jejunal limb down to the Roux-en-Y confluence. I incised the bowel to inspect its contents. There was a copious amount of blood found suggesting the source of the bleeding is from the jejunal limb. At this point, I felt the only other obvious source would be at the hepaticojejunostomy site. Attention was then brought back to this area where meticulous dissection was carried down to the anastomosis. An incision was made along the jejunm and large amounts of clot was evacuated exposing the marginal ulcer. There was some oozing as the base of the ulcer which was controlled with electrocautery. I did place a suture at this site which did appear to provide hemostasis. The resultant enterotomy was then closed suing suture for serosal and mucosal approximation. I then ran the bowel distally and there was found to be bile flowing from the efferent and afferent limbs at the Roux-en-Y anastomotic site. At this point, the Roux-en-Y incision was closed. The staple line was imbricated using a running suture. No evidence of leak and the bowel was placed back in the abdominal cavity.
Thanks so much everyone!!!!
We were hoping someone would have some suggestions on this procedure. The doc was unsure as well.
The patient was having bleeding and no one could figure out where it was coming from. Our guy went in to see if he could find it.
Post Op Dx: Marginal Ulcer
Procedure: Exploratory Laparotomy, Oversew of Marginal Ulcer of Hepaticojejunostomy Anastomatic Site
A midline supraumbilical incision was made through which sharp and blunt dissection was carried to the abdominal cavity. Of note, was a large incisional hernia with essential loss of domain. With care taken to avoid injury to the small bowel or colon, meticulous dissection was carried down through a thick layer of fibrotic tissue until I was ultimately within the abdominal cavity. Omental adnesions were taken down and I was able to identify the transverse colon. This was mobilized exposing the jejunal limb of her hepaticojejunostomy. Initial inspection was not consistant with intraluminal hemorrhage. I mobilized to the jejunal limb down to the Roux-en-Y confluence. I incised the bowel to inspect its contents. There was a copious amount of blood found suggesting the source of the bleeding is from the jejunal limb. At this point, I felt the only other obvious source would be at the hepaticojejunostomy site. Attention was then brought back to this area where meticulous dissection was carried down to the anastomosis. An incision was made along the jejunm and large amounts of clot was evacuated exposing the marginal ulcer. There was some oozing as the base of the ulcer which was controlled with electrocautery. I did place a suture at this site which did appear to provide hemostasis. The resultant enterotomy was then closed suing suture for serosal and mucosal approximation. I then ran the bowel distally and there was found to be bile flowing from the efferent and afferent limbs at the Roux-en-Y anastomotic site. At this point, the Roux-en-Y incision was closed. The staple line was imbricated using a running suture. No evidence of leak and the bowel was placed back in the abdominal cavity.
Thanks so much everyone!!!!