My surgical procedure in detail

Some may find this of interest. Enjoy. Don't try this at home kids.
Oldmike
Pathologic Findings

Necrotic rectum to level of pelvic floor, retroperitoneal
abscess, inflammation of the colon to the distal sigmoid

Detailed Description of Procedure

Patient was identified in the preoperative holding area by
the attending surgeon and was brought back to the
operative suite. Patient was positioned on the operating
table in the supine position again identified by the
operating surgeon and anesthesia was induced
uneventfully. Prior to prepping and draping a patient a
rectal exam was performed under anesthesia which
revealed nodular mucosa as well as a tight stricture at
about 7 cm from the anal verge. Patient was then
prepped and draped in the standard fashion. A midline
incision was made around the umbilicus using a knife and
the subcutaneous tissues were dissected to the fascia
using Bovie cautery. The midline of the fascia was then
grasped and elevated and the abdomen was entered
sharply. On initial inspection of the abdomen no

obvious fecal contamination was noted. The sigmoid
colon was identified and the white line of Toldt was
incised. Beneath the colon after incising the white line of
Toldt a large retroperitoneal abscess was visualized. The
abscess cavity was entered and copious amount of
malodorous stool and pus was expressed from the
retroperitoneum. The sigmoid colon was then

dissected laterally to medially off of the abdominal

wall and the abscess was found to be tracking down
around the rectum. The rectum was visualized and was
found to be frankly necrotic. Using a combination of blunt
dissection and Bovie cautery the mesorectum was
dissected away from the surrounding pelvic wall down to
an area of rectum that on palpation was felt to be intact.
A contour stapler was used to transect the rectum. The
rectal stump was then elevated from the pelvis, there was
copious remaining necrotic tissue and stool which was
debrided and the pelvis was irrigated. The rectum was
noted to be frankly necrotic with many obvious areas of
perforation, the distal sigmoid colon was additionally
noted to be thickened and inflamed without

obvious perforation or stricture. The remaining
retroperitoneum was then explored, the left ureter was
identified, and any remaining pockets of pus or

stool were drained and irrigated. No further bowel or
colon was noted to be abnormal in appearance. After
sufficient drainage and irrigation of his intra-abdominal
abscesses, a left-sided colostomy was formed. A

small circular incision was made on the left side of the
abdomen using Bovie cautery. The subcutaneous fat was
dissected using Bovie cautery, the anterior sheath was
opened using Bovie cautery the muscles of the rectus
sheath were split and the posterior sheath was incised.
The sigmoid colon was then passed to the hole. At this
point 3 JP drains were placed, the left-sided JP drain was
placed in the pelvis. The right lower JP was placed in the
retroperitoneum around the area of the kidney, and the
right upper JP was placed in the paracolic gutter. The
fascia was then closed with a running #1 loop PDS. The
skin was loosely stapled. The colostomy was then
matured by opening the distal staple line and using
chromic suture. An ostomy appliance was applied. The
patient was then awoken from anesthesia

uneventfully and was transferred to the leu for close
monitoring given the findings of severe contamination
during this case.

Specimeris Removed

Rectum and distal sigmoid

Implants/Grafts/Prosthetic Devices/Appliances

None

Estimated Blood Loss
100 cc

IV Fluids
Anesthesia note
Packs/Drains/Tubes

3 19 French channel JPs placed

Instrument and Sponge Count Correct?
Yes

Complications of Procedure
None

Condition of Patient at Time of Transfer
Stable

Attending Notes/Comments

(x_) I was personally present throughout the entire procedure.

L) I was present during (or personally performed) the key portions of this procedure, which included _, as well as
other portions. I was immediately available for the entire procedure between opening and closing.

L) I was personally present during the key portions of this procedure which included _. Dr. _ was immediately
available for the remainder of the procedure.

great diversion colitis
https://onlinelibrary.wiley.com/doi/full/10.1002/ueg2.12175

Post Edited (Old Mike) : 3/16/2022 7:45:21 AM (GMT-6)

Nope just tylenol. My main problems were zero sleep,for about 20 days,Ulnar nerve damage
which I am still dealing with, bladder pain after foley removal just now going away. Had no saliva,thats a real pain
to deal with. 20 pounds weight loss,just about back,but now have pot belly,surgical wound skin split all healed.
They were quite concerned white blood cell count was 40000,kidneys were at 11% function. Kidneys bounced back fast. The other pain was could not burp or change my own bag, since my right had did not work,my son had to do it for me,until I could move my hand enough.Then the wife broke both wrists,they are now pretty much healed. Now we have to deal with her 86 year old sister getting another heart vavle replacement. More fun.

I suspected a bag,also possibly no anus.
Funny about 20-30years ago had a dream,about being killed by my own bacteria. It almost happened.
Oldmike

Post Edited (Old Mike) : 2/27/2022 10:46:16 AM (GMT-7)

Wife is ok. No reversal that I know about. Bag is not too bad,as long as you can change it yourself.
Got a lot of tips on youtube on how to take care of skin and what not.
Would I still rather be connected normally, yes.
Oldmike

I am sorry that you had to endure all this

Old Mike fughtboutit we now will call you New York Tough Mike. Relax and recover my friend. God bless and be well😊

Holy moly, that’s a lot Old Mike! Twenty days of no sleep alone would have done me in. I hope your recovery is swift and that you’re able to deal with your ostomy bag yourself soon.