Operation Exploratory laparotomy with repair of colon perforation.
Description
The patient was taken back to the operating suite, placed in the supine position, sterilely prepped and draped in the usual fashion. Half percent Marcaine with Epinephrine was used at the incision site. An incision was made from the umbilicus up to the xyphoid process. The incision was carried down to the rectus fascia. The rectus fascia was incised. The peritoneum is elevated and the abdomen is opened. There are no adhesions to the abdomen. There is no soiling of stool in the abdomen. Visualization of the PEG tube showed the PEG tube going through a small portion of transverse colon. The amount of colon had a 0.5 cm bridge of tissue on 1 side with the majority of the colon without any injury. This was in between the abdominal wall and the stomach. There was no soiling of stool. There was no abscess here. I thought best to incise the bridge of colon and release the colon from the PEG tube. Once this was accomplished, I elevate the lumen of the colon created by the PEG tube and me cauterizing/releasing the transverse colon. The defect was 4 cm long. Good hemostasis is noted which is on the antimesenteric border. I thought secondary to the patient's cardiac history and the pristine surgical site that it would be best to take a laparoscopic GI stapling device 60 cm in length and fire this across the opening. I then invert the staple line with a 3-0 silk. Palpation of the lumen found it adequate. I dropped this back into the abdomen. Again there was no soiling. There was no abscess cavity noted. There was no active bleeding. I then left the PEG tube in place again as this looked pristine. I then closed the peritoneum with 0 Vicryl. I then reapproximate the rectus fascia with interrupted 1 Vicryl. I then closed the subcutaneous tissue with 3-0 Vicryl. I then reapproximate the skin using stainless steel clips. Xeroform and sterile dressing was applied. The patient tolerated the procedure well and went on to the recovery room in satisfactory condition. All sponge, needle and instrument counts were correct.