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: 25

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The transverse mesocolon is divided from right to left until the middle colic vessels can be isolated and divided.     

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The Anatomy of Colectomy: 26

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The continuation of transverse mesocolon is divided up to the splenocolic portion of the greater omentum. The latter is carefully divided to avoid tearing the splenic capsule. The left colic peritoneal reflection is then opened and the left colon mesentery liberated in the same manner as the right. Acute diverticulitis resection due to complications may necessitate leaving a closed rectal stump and bringing out a left-sided colostomy (Hartmannís procedure). A long colored suture end left on the rectal stump aids in localization when reanastomosis is performed.   

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The Anatomy of Colectomy: 27

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If total colectomy, or anterior resection of the rectum is being performed, the pelvic rectal peritoneal reflection is opened to expose the lower rectum. Subtotal colectomy (e.g. for toxic megacolon) or sigmoid colectomy do not require opening of the pelvic peritoneum and is much less morbid a procedure.      

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