Patient is 4 days post op from sigmoid colectomy with low pelvic anastomosis.

POSTOPERATIVE DIAGNOSES:
Sepsis.
Peritonitis.
Free air, free fluid on CT scan.
Perforation of recto-colon anastomosis.

OPERATION:
Exploratory laparotomy.
Opening of recent laparotomy incision.
Washout and drain placement.
Creation of double barrel ileostomy.
Small bowel resection.

Stool spillage in the abdomen with contamination of
pelvis and left quadrant.
Defect of anastomosis on right anterior aspect

**removed staples, separated the skin and subcutaneous tissues, and removed the previous #1 looped PDS sutures
**significant feculent material in the abdomen

GENERAL SURGEON WHO OPENED PATIENT WAS REPLACED BY ATTENDING SURGEON AT THIS POINT

**5 mm leak on the anterior right side of anastomosis
** bowel was extremely friable
**mesenteric injury at 20 cm proximal to the cecum.
**elected to resect the small bowel associated with the mesenteric rent and then brought up a double-barrel ileostomy in the
right lower quadrant
**attention to the double-barrel ileostostomy
**the proximal end brooked to approximately 5 cm, the inferior segment of the bowel we fashioned superiorly to the
proximal end, inferiorly we Brooked this slightly to the skin

Thanks in advance…