OPERATIVE REPORT (edited excerpt):
POSTOPERATIVE DIAGNOSIS: Closed loop small bowel obstruction, ischemic bowel mid-ileum approximately 30 cm. The bowel untwisted from an omental adhesion, peristalsing viable bowel, violaceous in nature with minimal mesenteric oedema, palpable pulses and Doppler signals.
Description: The violaceous 30-cm loop of mid-ileum greeted us upon entrance to the abdominal cavity. This de-torsed spontaneously and promptly. The bowel appeared violaceous, however, it was viable. After wrapping the bowel with warm, moist lap sponges, after a period of 10-15 minutes the bowel colour improved. Peristalsis was observed. No areas of necrosis were seen. Palpable pulses in the mesentery were observed and palpated. To ensure good blood flow, Doppler signals throughout the loop inside the antimesenteric side were appreciated throughout the mesentery of the concerning area. No excessive wall thickening or oedema was appreciated. Several small omental defects were seen. Electrocautery was used to open these defects as this was a concern for the suspected cause of an aetiology of the closed loop obstruction. Omentum was seen attached to the sigmoid colon in an abnormal position. This was divided in an avascular plane with electrocautery with care to not injure the bowel with electrocautery. Hemostasis was noted. The bowel was run from the ligament of Treitz to the ileocecal junction. All the other bowel was viable and within normal appearance...