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
- Use of Antibiotics?
Use of Antibiotics?
Gastric and intestinal surgery results in a clean-contaminated or contaminated procedures depending on spillage. Patients with foreign bodies are also at risk for intestinal bacterial overgrowth due to the obstruction. I administer perioperative antibiotics (first dose at induction and every 90 minutes during the procedure if applicable) in all patients with foreign bodies. In theory, cefazolin (1st generation cephalosporin) is indicated for surgery of the stomach and proximal intestine and cefoxitin (2nd generation) is indicated for surgery of the lower small intestine and colon. My antibiotic of choice is cefoxitin (2nd generation cefalosporin) – you never know what you will find! I administer antibiotics for a maximum of 24 hours unless severe contamination (peritonitis) is present in which case I give a full course but change the antibiotic if necessary once the bacterial culture results are available.