Operations on the intestines

The main types of operations on the intestine: stitching wounds ulcer - intergrafia; opening of the colon, followed by stitching - enterotomy (for example, removal of a foreign body of the bowel); the imposition of the stoma, i.e. artificial outdoor fistula cancer - eurostone, ileostomy, the colostomy (see Enterostomy) and anus praeternaturalis (see); the imposition of anastomosis, i.e. artificial internal inter-intestinal fistula, bypassing fatal obstacles in the gut (for example, if unavailable to remove the tumor); resection of the colon, i.e. the removal of the affected part of the colon with the restoration of its continuity through anastomosis or with the imposition of the anus praeternaturalis.


Fig. 3. The isolation site of the intestine:
1 - one curved clip;
2 - two direct clips.

Surgery on the gut always threatens contamination of the operating field of the intestinal contents. To protect the subject of the operation area of the intestine primarily void sdavlennoy, isolate, imposing mild intestinal clips (Fig. 3), and fence off napkins and tampons. Without clamps (finger sdavlennoy) you can do when stitching small single wound intestine. Having finished the work on the guts and removing the clips that change napkins, tampons, gloves and tools. For autopsy crossing intestine are small (often pointed) scalpel and direct, blunt scissors (see Surgical instruments). The remains of the content, resulting in a showdown ulcer, immediately remove aspirator and gauze balls. Stitching and stapling gut - see Intestinal suture. Bypass anastomosis impose, connecting ulcer side-to-side (Fig. 4); layer-by-layer staple begin to showdown guts on the back of the future anastomosis (Fig. 5).

anastomosis side-to-side
Fig. 4. Bypass bypass side-to-side.
the imposition of anastomosis
Fig. 5. The imposition of anastomosis side-to-side: 1 - imposed gray-serous seam, bowel opened; 2 - suture of the mucous membrane at the back of the anastomosis; 3 - imposed seam mucous membrane on the front wall of the anastomosis.

Resection of the colon is carried out at its extensive damage, tumors, tuberculosis, actinomycosis and other Most extensive resection (up to several meters) may require in gangrene of the bowel (as a result of inversion, infringing, thrombosis of vessels), yazvennom kolite. Subject resection loop isolated, imposing on each side for the two clamps. Together with a section of intestine is removed and an appropriate proportion of its mesentery, issaka from it Klin, aimed the tip to the root of the mesentery (Fig. 6). We cross the vessels capture terminals or in advance tie with ligatures. Anastomoses after resection impose different (Fig. 7).

resection of the colon
Fig. 6. Resection of the colon.
types of anastomoses
Fig. 7. Types of anastomoses: 1 - the end to end; 2 - side-in the end; 3 - isoperistaltic imposition of anastomosis; 4 - end side.
ileotransverse
Fig. 8. Ileotransverse. Imposed anastomosis side-to-side, sewn defect mesentery and parietal peritoneum.

Restoring aceptic operating margins, changing tools, cutting a defect in the mesentery to avoid infringing it intestinal loops (Fig. 8). Resection of small sections of the intestine does not affect the digestion. After extensive resections of the small intestine is disturbed digestion and assimilation of food; patients deprived of the most part of the colon, suffer from diarrhea. Patients after operations on the intestines need a special mode as instructed by the doctor.
Events after operations on the intestine - see the Postoperative period.
Cm. also bowel Obstruction.