Chapter 11: Table of Contents
- 11.1 Intestinal Biopsy
- 11.2 Intestinal Biopsy Quiz
- 11.3 Intestinal Resection and Anastomosis
- Intestinal Apposition and Closure
- Suture the mesenteric rent, leak test, and omentalize
- Video: Intestinal Resection and Anastomosis
- How to accommodate discrepancies in luminal size when performing a resection-anastomosis
- Decision-making in the management of gastrointestinal foreign bodies
- Decision-making in the management of gastrointestinal foreign bodies: continued
- Decision-making in the management of gastrointestinal foreign bodies continued
- Enterotomy vs. Resection-Anastomosis
- Assessing Intestinal Viability
- Where to incise when removing a focal foreign body via enterotomy?
- Linear foreign body removal
- Where to cut when performing a resection-anastomosis
- Prognosis- foreign body
- Complications
- Use of Antibiotics?
Complications
- Dehiscence and septic peritonitis is the most common complication after foreign body removal; this is reported in 7-16% of patients. Dehiscence has been reported to be more common after resection-anastomosis than after enterotomy (Allen 1992). The rate of dehiscence is reportedly higher in patients that receive an enterotomy for foreign body removal or trauma compared to biopsy (Allen 1992, Weisman 1999) and when more than one enterotomy or resection-anastomosis is required (Wylie 1994). Abdominal contamination can lead to localized or generalized peritonitis, which increases the risk of dehiscence (Allen 1992).
- Dehiscence typically occurs 2-5 days after surgery. Reported mortality rates after dehiscence are between 50-74%. Abdominal effusion, anorexia and vomiting are common signs.
- Dehiscence is often secondary to an enterotomy being performed when a resection-anastomosis should have been performed (questionable intestinal viability). Other causes include poor suture material choice and poor suture technique. Post resection-anastomosis leakage tends to occur at the mesenteric border because it is a difficult area to suture (hidden by mesenteric fat).
- Ileus is another common complication after gastrointestinal foreign body surgery. Signs of ileus are typically noted within 24 hours of surgery. Medical management using prokinetic drugs is usually successful.
