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Bleeding control following division of ileocolic vessels close to the superior mesenteric vessels in an obese patient

Authors

Abstract

The objective of this film is to demonstrate the operative strategy in case of bleeding in contact to large vessels, and here the superior mesenteric vein following division of the ileocolic vessels.

Classification

tips and tricks

Keywords

Bleeding control following division, ileocolic vessels, superior mesenteric vessels, obese patient

Media type

Duration

01'56''

Publication

2010-01

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E-publication

WeBSurg.com, Jan 2010;10(01).
URL: http://www.websurg.com/doi-vd01en2860.htm

Bleeding control following division of ileocolic vessels close to the superior mesenteric vessels in an obese patient

1. Introduction 00'09''

The objective of this film is to demonstrate the operative strategy in case of bleeding in contact to large vessels, and here the superior mesenteric vein following division of the ileocolic vessels. In this obese patient, bleeding occurs. It is situated in the area from the superior mesenteric vessels.

2. Bleeding 00'34''

We can observe how important the blood flow is and there are some bubbles. At this moment in time there are two options: either a transient hemostasis using atraumatic compression along with the preparation of the opening of the abdominal cavity to understand and perform an elective hemostasis as in the present case; the other solution according to the same principle, is to perform all laparoscopically.

3. Laparoscopic Satinsky clamp introduction 00'59''

Following the compression we introduce a laparoscopic vascular Satinsky clamp directly through the abdominal wall.

4. Bleeding point identification 01'05''

We have to identify the bleeding point in contact to the superior mesenteric vein. It was the stump of the ileocolic vein that had been divided but not sealed by the Ligasure Atlas® 10mm device because of the morbidly obese character of the patient.

5. Hemostasis 01'30''

The Satinsky clamp is maintained and hemostasis is performed electively as could have been done in open surgery. This option can be envisaged if the surgeon reacts well and if bleeding is not too important thanks to elective atraumatic compression.

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