Editing Small bowel obstruction (section)

=== '''Operation''' ===

* Midline laparotomy, taking care to avoid adhesions
* Lyse all adhesions necessary for safe visualisation of bowel
** It is not necessary to completely free the entire bowel - focus on the area of TP (and distal to that point if a bowel resection is performed)
** With frozen abdomen/bowel, you probably do need to release the entire bowel though.
** Enterotomies: leave superficial serosal tears alone, but repair anything where the mucosa pouts through the defect
* Run small bowel - start with a collapsed loop, and follow it proximally until the TP is identified. If no collapsed bowel is seen, start at ICV.
** If mass or neoplasm is encountered, needs to be resected with 8-10cm margins + lymphatics, and remember to look at abdomen for evidence of metastases
* Repair hernias - biologic mesh if contamination, otherwise synthetic as normal
* Evaluate bowel for ischaemia
** Fluoroscein dye - 500 to 1000mg IV in 10% solution - then use Wood's lamp to check perfusion
** Leave dusky bowel for 10 minutes and reassess before resecting
* Decompress the bowel by milking it back to the stomach