A Technique of Identifying the Rectal Stump in Patient’s With Hartmann Pouch Before Closure, By Tattooing With India Ink (spot)

Sushil Pandey, MD, Hadi Najafian, DO FACS FASCRS, Pedram Motamedi, Paravasthu Ramanujam, MD FACS. West Valley Colon & Rectal Surgery Center

 

Objective: Identification of the rectal stump in a patient during Hartmann closure can be difficult and the dissection can be tedious. Many techniques had been used mark the rectal stump with non-absorbable sutures and even to tack it to the lateral pelvic wall. We describe the simple technique of endoscopy tattooing of the end of the rectal stump with 3-5 cc of India ink to facilitate easy identification both during laparoscopy or open laparotomy.

Technique: Patient was status post Hartmann’s procedure presented for reversal of colostomy. Prior to surgery, patient was brought to the endoscopy lab after cleansing the rectal stump with enemas. This technique usually does not need any sedation and can also be done in the office setting. Patient was placed on the left lateral position. The flexible sigmoidoscope was inserted to the rectum through the anus. The rectal stump was intubated and the end of the rectal stump is identified. Using endoscopic sclerotherapy needle, 2-5 cc of India ink, (SPOT) was injected slowly. Once the tattooing was done, the scope is gently withdrawn.

Pict 1: Tattooing of rectal stump preoperatively

Pict 2. Identification of rectal stump (upper left side) with the help of tattoo during Laparoscopic surgery

Pict 3: Identification of rectal stump (center) with the help of tattoo during open surgery

Results: In our experience, the identification of rectal stump in both open and laparoscopic reversible of Hartman’s is relatively easy when rectal stump is tattooed pre-operatively. Thus it facilitates the rectal dissection for colorectal anastomosis.

Discussion: India ink is commercially available called Spot which is approved by the FDA. During laparoscopy the distinct tattooed end of the rectal stump can be easily seen, facilitating identification and dissection of rectal stump. In open laparotomy, the tattooed rectal stump is clearly visible. This technique of injecting India ink to the end of the rectal stump is simple, safe and significantly facilitates the identification of the rectal stump, thus facilitated rectal dissection and anastomosis.


Session Number: Poster – Poster Presentations
Program Number: P068
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