Surgeon's Corner: Enterotomy

Presentation

The patient presented with acute vomiting, chronic nausea, anorexia, depression, and watery and fetid diarrhea. Abdominal radiographs suggested a GI foreign body, and an abdominal exploratory laparotomy was performed.

Surgery

Complete abdominal exploratory revealed a focal area suspicious of an intestinal foreign body. The oral bowel appeared hyperemic (almost hemorrhagic) from trauma induced by migration of the sharply pointed foreign body through the small intestine. The aboral bowel appeared viable, although hyperemic. An enterotomy was performed once the section of bowel was exteriorized and packed-off. Care was taken to make a longitudinal incision through the antimesenteric border of the aboral intestine in order to remove the foreign body, avoiding any unhealthy bowel. The foreign body was manipulated and removed through the enterotomy site using Allis tissue forceps. Closure of the bowel wall was performed using a simple continuous appositional suture pattern, starting and finishing beyond each commissure of the incision. Each bite was taken 3-mm beyond the cut edge of the serosa and into the lumen of the intestine, with each suture placed no further than 2 to 3-mm apart. The last throw was beyond the commissure of the enterotomy site. After local lavage and inspection of the enterotomy site, the abdominal cavity was lavaged and the laparotomy site was closed routinely. Simple continuous appositional suture patterns were used for closure of both the body wall and the skin.

Outcome

The patient clinically improved within 1 day, and sutures were removed 1 week later.

This video was authored by Howard B Seim III, DVM, DACVS. Other surgical videos are available through VideoVet.

Surgeon’s Corner is intended as a forum for those with specialized expertise to share their approaches to various techniques and procedures. As such, the content reflects one expert’s approach and is not subject to peer review.