Right Dorsal Colon or Descending Colon Enterotomy Technique
For all of these procedures, at least one enterotomy will be necessary.
Whenever an antimesenteric taenia is present, the enterotomy incision
should be located within the center of the taenia (right dorsal colon or
descending colon) (Archer et al 1988; Beard et al 1989).
Unless the enterotomy will be in a segment that can be exteriorized away
from the abdomen, such as the pelvic flexure, the affected segment of
intestine should be isolated from the rest of the abdomen with moistened
laparotomy sponges and sterile plastic barrier drapes. If the targeted
intestine is being elevated under tension, the segment can be supported
and elevated by a sterile hand within the abdomen. Stay sutures (or
Babcock forceps) should be used within the taenia prior to the
enterotomy incision to stabilize and elevate the site to reduce
contamination. Suction should be used throughout the procedure to
aspirate blood and ingesta to minimize leakage of intestinal contents
and contamination of the surgical field. Closure of the enterotomy
should be done in two layers using 2-0 absorbable suture: a full
thickness apposition continuous pattern for the first layer and oversewn
by an inverting seromuscular continuous pattern (Hassel 2002). While the
inclusion of mucosa within descending colon enterotomies has not been
determined to be essential (Beard et al 1989), it does appear to
be advantageous to compress submucosal vessels for the large colon
(Doyle et al 2003). Since intramural or submucosal hematomas can
occur spontaneously in the descending colon (Hanson and Schumacher 2021;
Schumacher and Mair 2002), full thickness closure of descending colon
enterotomies appears prudent as well. While lumen diameter is not
limiting for closure of right dorsal colon enterotomies, it is important
to be precise with conservative suture bite sizes and minimal inversion
when closing descending colon enterotomies. The enterotomy site should
be carefully lavaged and cleaned of any contamination before the
intestinal segment is returned to the abdomen.