PROCEDURE: Exploratory laparotomy with small bowel resection with
ileocolonic and side-to-side anastomosis and decompressive

SURGEON: Dr. Redcross.


BRIEF HISTORY: Ms. Irving is a 77-year-old African-American gentleman
who recently had a right hemicolectomy secondary to cancer.
Postoperatively, the patient had continuous distention of his abdomen
with a severely distended stomach. Because the patient did become
septic, thus, we are taking the patient to the operating room to
evaluate small bowel obstruction.

DESCRIPTION OF PROCEDURE: The patient was taken back to the operating
theatre, placed on the operating table in the supine position. Upon
proper identification with the time-out procedure, the patient was
sedated, intubated, prepped and draped in a sterile fashion. We
removed the previous staples in the abdominal cavity with minimal
amount of adhesions. The stomach was grossly distended. Upon
running the bowel, there appeared to be an internal hernia at the area
of the anastomosis. The bowel proximal to this internal hernia was
dilated and the distal bowel was decompressed. I then made a small
incision in the stomach to decompress the grossly distended stomach
We removed a large amount of air. I then placed a Babcock on the
small incision and introduced a TA30 stapler, fired to close the
gastrostomy. I oversewed the stomach with 3-0 silk suture. I then
proceeded to take down the previous anastomosis. I fired a GIA
stapler in the small bowel followed by GIA stapler on the transverse
colon. I took down the mesentery between hemostats and LDS stapler.
The anastomosis was then passed off the operative field. We then
recreated the anastomosis in a side-to-side fashion, secured the bowel
with 3-0 silk suture. We made an enterotomy, introduced the GIA 75
stapler and fired. I then closed the anastomosis with a running 3-0
Vicryl suture. I oversewed the suture line with 3-0 silk suture in
interrupted fashion. We closed the mesenteric defect with running 3-0
Vicryl suture. We then irrigated with two liters of normal saline.
We introduced a JP drain in the right upper quadrant. I checked for
placement of the NG tube which was in the distal stomach. We then
irrigated again with a liter of normal saline and proceeded to close.
We closed with running double stranded PDS No. 1 suture. We then
irrigated the subcutaneous tissue and left the skin open. We placed
a wet-to-dry dressing on the skin. All counts were correct. The
patient was transferred to the ICU, intubated, in stable condition.