66.13 Injuries of the right colon from the caecum to the hepatic flexure

The usual options are a right hemicolectomy or exteriorization. A hemicolectomy is best. If you don’t feel capable of doing an anastomosis, you can bring the ends of the patient’s gut out as an ileostomy and a mucous colostomy.

Figure 66.20: RIGHT HEMICOLECTOMY A, incising the peritoneum on the right of the patient’s ascending colon. B, using blunt dissection to reflect his right colon medially. C, freeing his colon from his duodenum. D, a fan shaped piece of the mesentery of the right colon is being excised. E, the end of his transverse colon is being closed with continuous catgut over a straight non-crushing clamp. F, a single layer of mattress sutures is being placed in the end of his colon. G, his small intestine, still held in its clamp, is being drawn upwards. H, a crushing clamp is being placed on the anterior taenia. 1, the serosal surfces of the two pieces of gut are being joined. J, part of the anterior taenia is being excised. K, the mucosa is being approximated. L, the anterior wall of the anastomosis is being closed. M, some extra mattress sutures are being inserted. N, the final result. This figure does not show the final closure of the mesentery-don’t forget to do this. Partly after Ellit with kind permission.