Practical Gastroenterology and Hepatology Board Review Toolkit

Nicholas J. Talley , Kenneth R. Devault, Michael B. Wallace, Bashar A. Aqel, Keith D. Lindor


63.1 Endoscopic palliation of complete malignant colonic obstruction

The abdomen is marked for planned laparoscopic port placement in the supraumbilical, left lower quadrant and suprapubic position. The 10 mm 30° laparoscope is inserted through the supraumbilical port and two dissecting instruments are introduced through the other ports. The appendix is evaluated and the diagnosis of acute appendicitis is confirmed. The appendix is elevated with a blunt grasper. An avascular window is created bluntly between the base of the appendix and the mesoappendix. This window is widened in order to accommodate the bottom jaw of the laparoscopic stapling device. The appendix is divided at the base of the cecum, making sure not to impinge on the terminal ileum. Next, the mesoappendix is divided using a vascular load of the EndoGIA stapler. The specimen is placed in an Endocatch bag in preparation for extraction. The staple line is inspected for integrity and hemostasis and the right lower quadrant is irrigated. The Endocatch bag is removed through the supraumbilical port and all the ports are closed.