DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Prolapsed diverting colostomy.
POSTOPERATIVE DIAGNOSIS: Prolapsed diverting colostomy.
PROCEDURE PERFORMED: Partial transverse colectomy and a complex revision of colostomy.
SURGEON: John Doe, MD
ANESTHESIA: General.
SPECIMEN: Transverse colon.
CONDITION: Stable.
INDICATIONS FOR PROCEDURE: This is a (XX)-year-old gentleman with history of obstructing rectal mass who actually had undergone a diverting transverse loop colostomy one month ago. The patient had elected to not proceed with definitive surgical resection after meeting with his primary care physician and his oncologist. The patient was placed mostly on comfort care only. However, over the last three days or so, the patient reports a large amount of rectal tissue protruding through the existing ostomy causing minimal discomfort, but it was noted there is significant decrease of stool output. The patient otherwise has no abdominal pain. Because of the discomfort and partial obstruction as a result of severe edema and the fact that we were unable to reduce the prolapsed portion, the patient now presents to the OR for repair.
DESCRIPTION OF PROCEDURE: After informed consent was obtained, the patient was taken to the OR and prepped and draped in sterile fashion. An elliptical skin incision was made around the pre-existing ostomy. The transverse colon was then dissected away from the surrounding tissue, and again, there was a large amount of redundant proximal transverse colon that we can easily bring out through this opening. At this point, we elected to resect the redundant transverse colon. The mesentery was then ligated and divided using LigaSure device until just enough of the transverse colon could be brought out to the level of the skin to create the ostomy. At this time, we elected to convert into an end transverse colostomy with a mucous fistula because of the distal obstruction. Some of the distal transverse colon was also resected again just so it was flush with the skin. The proximal portion was then sutured circumferentially to the dermis using 3-0 Vicryl suture. Approximately half of the distal staple line was then excised, and a mucous fistula was then created by again using the similar technique by suturing full thickness of the bowel wall to the dermis circumferentially. The two ends of the colon were also sutured together so it is flush with the skin. The ostomy appliance was then reapplied. The patient was returned to recovery in stable condition.
