Novel technique for intra-operative evacuation of an obstructed bowel (ASA technique)

Intra-operative management of obstructed distended bowel poses a risk of spillage and contamination. Here we describe our novel surgical technique for intra-operative evacuation of a distended, stool-filled obstructed bowel using a standard Mayo's stand cover. The bowel segment proximal and distal to the obstruction is mobilized. The bowel is transected distally. A Mayo's stand cover is attached to the edge of the incision with clamps, creating a sterile collection pouch. The mobilized bowel is exteriorized into the bag. An enterotomy is made just proximal to the obstruction, allowing the stool to evacuate into the bag. Manual antegrade bowel decompression is used to assist emptying. The bowel is then transected proximally and both the resected segment and the bag are removed. The procedure continues with primary anastomosis or stoma formation. Our novel technique provides an effective method to safely decompress a dilated bowel segment while minimizing contamination.