Laparoscopic resection and anastomosis of a jejunal sealed off perforation - Case Study

By, Dr Harsh Sheth, Bariatric Surgeon in Mumbai

1. OVERVIEW

Upper-bowel perforation can be described as either free or contained. Free perforation occurs when bowel contents spill freely into the abdominal cavity, causing diffuse peritonitis. Contained perforation occurs when a full-thickness hole is created by an ulcer, but free spillage is prevented because contiguous organs wall off the area.

Lower-bowel perforation results in free intraperitoneal contamination.

II. DOCTOR NAME

Dr. Harsh Sheth

III. PATIENT DETAILS

Age : 76, Male

IV. SYMPTOMS

Severe pain in abdomen on the right side, vomiting, redness of the skin and distension of the abdomen more on the right side.

V. TEST PERFORMED

CT scan (abdomen+pelvis) plain with iv contrast

VI. DIAGNOSIS

Sealed off jejunal perforation

VII. TREATMENT

Laparoscopic resection and anastomosis of a jejunal sealed off perforation

VIII. DESCRIPTION OF THE TREATMENT

Pleased to share a recent case of ours, 76 year old man who presented with localised pain in the right hypochondrium with CT suggestive of an intra-abdominal abscess with a sealed off intestinal perforation.
On a diagnostic laparoscopy, there was a sealed off perforation in the jejunum with a walled off abscess cavity.

We proceeded laparoscopically and performed a totally intra-corporeal (laparoscopic) resection and anastomosis of the jejunum with 4 laparoscopic ports and extracted the specimen through a small umbilical incision.

IX. POST TREATMENT GUIDELINES

Gradual re-introduction of diet to the patient

X. IMAGES