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Enterotomy vs. Resection-Anastomosis

Chapter 11: Table of Contents

Enterotomy vs. Resection-Anastomosis

Radiograph of gastric foreign body

Gastric foreign bodies are removed by gastrotomy (see the section on gastrotomy). I have yet to resect a portion of the stomach secondary to a foreign body. In contrast, intestinal foreign bodies can cause significant devitalization of the affected loops of bowel, which may need to be resected. Therefore, the questions to ask when evaluating a patient with an intestinal foreign body are: 1) whether or not the affected intestine is viable (enterotomy vs resection-anastomosis) and 2) if the intestine is not viable, how much intestine must be resected. Unless the tissues are obviously necrotic, viability is often difficult to determine. If I have any doubt as to whether or not the intestinal loop is viable, I resect it. In some instances, I perform an enterotomy to remove the foreign body and I reassess viability after the intraluminal pressure has been reduced. If I am unsure about viability using the criteria described below, I proceed with a resection-anastomosis. 

Enterotomy to remove foreign body in small intestine

If the intestine is viable, I perform an enterotomy since the rate of dehiscence with resection-anastomosis is reportedly higher than that associated with an enterotomy (Allen 1992). The rate of dehiscence is also higher in patients that receive an enterotomy for foreign body removal compared to biopsy (Allen 1992, Weisman 1999) and when more than one enterotomy or resection-anastomosis is performed (Wylie 1994).

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