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.