VSR 421: Regional Veterinary Surgery (2+1)

 ENTEROTOMY

• Enterotomy is an incision into the intestine

Indication

• Gastrointestinal obstruction.
• Neoplasms
• Diagnostic purpose eg: biopsy

Surgical technique

• The diseased or desired intestinal segment is isolated from the abdomen by packing with towels or laparotomy sponges. 

Isolated the intestine

 

• Gently milk the intestinal contents from the lumen of the identified intestinal segment.
• Occlude the lumen at both end of the isolated segment by having an assistant use a scissor like grip with the index and middle fingers 4 to 6 cm on each side of the proposed enterotomy site.
• Or use a noncrushing intestinal forceps (Doyen)
• Make a full thickness stab incision into the intestinal lumen on the antimesenteric border with a No:11 scalpel blade.
• By making a second longitudinal incision parallel to the first with the scalpel blade , we can obtain full-thickness biopsy samples 4 to 5mm wide.
• Alternately by removing an ellipse of intestinal wall at one margin of the first incision with Metzenbaum scissors.
• Close incision with simple interrupted sutures.
• Use simple continuous or crushing sutures to close the enterotomy incision.
• If enterotomy has to be performed for removal of foreign body, make an incision in healthy appearing tissue distal to the foreign body.
• Using Metzenbaum scissors lengthen the incision along the intestine’s long axis to allow removal of foreign body without tearing the intestine.
• After removal of foreign body, prepare the incision for closure by trimming the everted mucosa so that its edge is even with the serosal edge.

Removal of foreign body

• Sutures are placed through all layers of the intestinal wall 2mm from the edge and 2 to 3mm apart with extraluminal knots.
•  Use monofilament, absorbable suture material (4-0 or 3-0) with a swaged-on taper or tapercut point needle.

 

Enterotomy wound suturing

• Apply gentle digital pressure and observe for leakage between sutures or through needle holes.
• Lavage the isolated intestine and entire abdomen if contamination have occurred.
• Omentum can be placed over the suture line (omentalisation) before closing the abdomen, to facilitate healing.
• Replace contaminated instruments and gloves before closing the abdomen.