From the Guidelines
Enterotomy should be managed with explorative laparoscopy as the first line of treatment, as it allows for both diagnostic and therapeutic procedures, reducing morbidity and mortality rates 1. When performing an enterotomy, it is crucial to consider the size, location, and etiology of the perforation, as well as the patient's general status and presence of comorbidities 1. The decision to perform an enterotomy should be made after a careful inspection of the whole colon and peritoneal cavity. Some key points to consider when managing an enterotomy include:
- The use of laparoscopy to visualize the parietal defect and its size and specific location 1
- The potential for laparoscopic primary repair if the size of the tear is small and the colon is healthy and well perfused 1
- The importance of evaluating the presence of potential signs of peritonitis and performing aspiration, culture, and irrigation of the peritoneal cavity if necessary 1
- The consideration of explorative laparoscopy in questionable situations to rule out the need for further treatments, including laparotomy 1 Overall, the management of enterotomy requires a careful and individualized approach, taking into account the specific circumstances of each patient and the potential benefits and risks of different treatment options 1.
From the Research
Enterotomy
- Enterotomy is a surgical incision into the intestine, often performed to repair a damaged or diseased portion of the bowel 2.
- The risk of surgical site infections (SSIs) is high in colorectal operations, with rates ranging from 6% to 30% 2.
- The use of prophylactic antibiotics, such as ceftriaxone and metronidazole, can decrease the rate of SSIs in elective colon surgery 2, 3.
Complications of Enterotomy
- Intestinal fistulae are a potential complication of enterotomy, with a closure rate of 24-72% under conservative medical treatment 4.
- Octreotide and somatostatin have been used to treat intestinal fistulae, but their effectiveness is still debated 4, 5, 6.
- Somatostatin and dexamethasone have been shown to promote resolution of bowel obstruction and shorten hospital stay in patients with early postoperative small bowel obstruction with obliterative peritonitis 5.
Management of Enterotomy Complications
- Conservative management of intestinal fistulae with total parenteral nutrition, octreotide, and somatostatin can be effective in some cases 6.
- The use of ceftriaxone and metronidazole as empirical therapy for complicated intra-abdominal infection is appropriate in some cases, but broader spectrum antimicrobial therapy may be necessary in cases involving perforated bowel or sigmoid diverticulitis 3.