c l i n i c a l f o l i o s : n a r r a t i v e





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The Anatomy of Colectomy: 13

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The body and antrum of the stomach overly the transverse mesocolon.       

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The Anatomy of Colectomy: 14

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The gastrocolic portion of the greater omentum is closely applied to the transverse mesocolon, particularly along the distal greater curve. The safest place to divide the gastrocolic omentum is outside the gastroepiploic arcade to the left side of the greater curve where there is more separation between the two layers. Entering farther toward the right risks going through both gastrocolic omentum and transverse mesocolon and damaging the middle colic vessels.      

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The Anatomy of Colectomy: 15

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The most precise way of identifying and controlling major colonic vessels is to transilluminate the mobilized mesocolon. The relatively avascular territories between vessels can be divided with cautery, leaving less tissue around the major vessels, which can then be isolated, clamped divided and ligated. The proximal end of major pedicles should be suture ligated as well as the initial ligation for security.    

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This page was last modified on 9/15/2009.