To be considered effective, a staple line must allow adequate tissue perfusion while minimizing bleeding and tissue destruction. The ‘B’ shape allows for high delivery profile, whereas the ‘D’ shape relies on a low-profile of the applicator. There are two forms currently in use: ‘B’ and relatively newer ‘D’. Intestinal staplers work by bringing the edges of wounds together along with blood vessels essentially acting as a hemostat and sealer to the area. Surgical staplers have been in widespread usage since the 1970s. In this report, we describe the malfunctioning of an Endo-GIA stapler in a large bowel resection. Patient was discharged after 8 weeks in fair condition to a nursing care facility. Patient required on-going resuscitative hydration with IV fluid boluses to compensate for his high output ileostomy. His post-operative management was complicated by high ileostomy output which did not readily slow with multiple modalities to control gastrointestinal loss. The patient required delayed abdominal wound closure due to recurring intra-abdominal sepsis. His hospital course was complicated by recurrent ileostomy necrosis and futile wound healing, resulting in colonic suture breakdown with recurrent fecal peritonitis and septic shock, acute renal failure requiring dialysis, acute respiratory failure requiring trach and right upper extremity deep venous thrombosis. A contour stapler was then used instead of the powered stapler for segmental transection of the ascending colon.
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Repeated attempts to override using the manual handle failed and it took over 10 min to separate the stapler sides.
The stapler abruptly froze a sound went off and it became locked.
Midway through, another attempt to transect the proximal part of ascending colon using powered Endo-GIA stapler failed (Fig. The patient was taken back to the operating room for exploratory laparotomy and repair of the dehiscence. A few days later, dehiscence of the staple line on the ascending colon occurred. All the mesentery between the two transected points was taken down using the ligature. The cecum was transected using a 75 mm GIA blue load. The proximal part of the cecum was freed from peritoneal attachment.
Approximately 7 cm proximal to the ileocecal valve, the terminal ileum was transected using a 55 mm GIA blue load. During the procedure, mild hyperemia of the appendix was noted. Patient was prepared and positioned for surgery in supine position. Patient was promptly taken to the operating room for an exploratory laparotomy, ileocecotomy, appendectomy, drainage of abscess and ileostomy. Computed tomography (CT) Imaging was concerning for ruptured appendicitis and clinical exam was consistent with peritonitis and sepsis. Physical exam revealed non-radiating pain localized to the right lower quadrant absent of alleviating or exacerbating factors and without associated symptoms. A 72-year-old man with past medical history including hypertension, chronic kidney disease, cerebrovascular disease and chronic obstructive pulmonary disease presented to the emergency department with altered mental status and abdominal pain.
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