Friday, August 22, 2014

Small Bowel Resection



8.  Small Bowel Resection and Entero-Enterostomy
Objective
In case of small bowel obstruction due to:
•   Inflammation
•   Tumor.
     Bypass the obstruction or remove the deceased segment and restore continuity of the bowel.
Position
Supine.
Anesthesia
General.
Procedure
1.  Open the abdomen gain entry to the peritoneal cavity.
2.  Identify area to be resected.
3.  Divide mesentery to this area in the line of a shallow V, serially between ligatures.
4.  The apex of the V is toward the root of the mesentery.
5.  Divide bowel to be removed obliquely, removing more of antimesenteric border between noncrushing clamps.
6.  Approximate noncrushing clamps to appose the two cut ends of bowel.
7.  Carry out end to end anastomosis—an inner continuous layer of catgut and an outer continuous layer of silk.
     Approximate cut end of mesentery with interrupted sutures.
Instruments
•   General set, 1
•   Gastrointestinal set, 1.
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