Closure of a Simple Transmural Injury to the Small Intestine
An injury to the wall of the small intestine incurred during a pelvic dissection can be managed without resorting to an intestinal resection if the blood supply to the bowel segment has not been interrupted. Observation of the intestine will show the bowel to maintain a healthy pink color (Fig. 95–1). Next, the edges of the wound should be trimmed with a fine scissors (Fig. 95–2A, B). The cut edges should bleed to further indicate healthy intestinal tissue. Next, a through-and-through closure utilizing 2-0 or 3-0 chromic catgut is placed as interrupted sutures (Fig. 95–2C). A second imbricating layer of 2-0 interrupted silk is sutured into the muscularis and serosa (Fig. 95–2D through F). The suture line is irrigated and the bowel lumen is checked for adequacy between the surgeon’s thumb and fingers.
