Name of the Procedure:

Suture of Small Intestine (Enterorrhaphy) for Perforated Ulcer, Diverticulum, Wound, Injury, or Rupture; Single Perforation

Summary

Suture of the small intestine, known medically as enterorrhaphy, is a surgical procedure to repair a perforation (hole) in the small intestine. The procedure involves stitching the perforation to close the hole and restore the integrity of the intestinal wall.

Purpose

The procedure addresses conditions such as perforated ulcers, diverticula, wounds, injuries, or ruptures in the small intestine. The main goals are to close the perforation, prevent infection, and restore normal function of the small intestine.

Indications

• Acute abdominal pain and localized tenderness indicating a perforation.
• Evidence of a perforated ulcer, diverticulum, or intestinal injury on imaging studies.
• Signs of infection or sepsis secondary to intestinal perforation.
• Patients with specific symptoms such as severe abdominal pain, fever, nausea, vomiting, and signs of peritonitis.

Preparation

• Patients are typically required to fast for at least 8 hours before surgery.
• Discontinuation of certain medications as per physician instructions (e.g., blood thinners).
• Preoperative blood tests, imaging studies (like CT scan), and a complete medical history review.
• Administration of intravenous fluids and antibiotics as a preoperative measure.

Procedure Description

1. The patient is given general anesthesia to ensure they are unconscious and pain-free.
2. An incision is made in the abdominal wall to access the small intestine.
3. The perforated section of the intestine is identified.
4. The perforation is carefully stitched using surgical sutures to close the hole.
5. The abdominal cavity is washed out with sterile saline solution to remove any potential contaminants.
6. The abdominal incision is closed with sutures or staples.

Duration

The procedure typically takes 1 to 2 hours, depending on the complexity and severity of the perforation.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Lead Surgeon
• Surgical Assistants
• Anesthesiologist
• Scrub Nurse
• Circulating Nurse

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Adverse reactions to anesthesia
• Leakage from the suture site
• Bowel obstruction or ileus
• Injury to surrounding organs
• Risk of sepsis if the perforation is not adequately managed

Benefits

• Immediate stabilization of the intestinal perforation
• Prevention of peritonitis and sepsis
• Restoration of normal intestinal function
• Relief from severe abdominal pain and associated symptoms
• Patients usually begin to experience relief from symptoms within a few days post-surgery.

Recovery

• Hospital stay of several days to monitor recovery.
• Gradual reintroduction of food and fluids, starting with clear liquids.
• Pain management with prescribed medications.
• Instructions on wound care to prevent infection.
• Avoidance of heavy lifting and strenuous activity for several weeks.
• Follow-up appointments to monitor healing and progress through imaging and clinical assessments.

Alternatives

• Conservative management with broad-spectrum antibiotics (in select, stable patients).
• Endoscopic repair procedures (where applicable and feasible).
• Each alternative comes with its own risks and benefits. Conservative management can avoid surgery but may not be effective in severe cases. Endoscopic repair is less invasive but may not be suitable for all types of perforations.

Patient Experience

• During the procedure, the patient will be under general anesthesia and will not feel any pain.
• Postoperatively, the patient may experience pain at the incision site, managed with pain relief medications.
• The patient may encounter some discomfort from the surgical wound and may need assistance with mobility initially.
• Full recovery can be expected within a few weeks, with careful adherence to post-operative instructions and follow-up care.