(Emotionally Honest) Surgery Report

Procedure: Godawful Exploratory Laparotomy, Intestinal Resection and Anastomosis

Date of Surgery: 10/3/2025
Surgeon: Greg Bishop, DVM
Patient Name: "Bonkers" McGibb
Signalment: 2 year old MN Labrador

Preoperative Diagnosis:

What a nightmare! This frikkin 2-year-old lab has been vomiting for four days like he's a prop from Pet Sematary 4. But, to be honest, his X-rays weren't convincing. So I asked a colleague to take a look, but she's a pretty noncommittal new grad, and wouldn't do my job for me, so...

Anyway–I was pretty sure the dog had an intestinal obstruction before slicing in.

Postoperative Diagnosis:

Phew! Turns out I was right! There was an obstruction! I made sure to warn the owners a negative explore would have been their fault and they could suck it (at least I didn't have to sweat out that phone call). It's such a relief to have actually gotten a diagnosis correct, but I'm not the world's most confident surgeon, so at this point (freaking about sepsis), maybe it would have been better if I had gone to law school.

Oh yeah, it was a group of toy green army men requiring resection and anastomosis of the mid jejunum.

Anesthesia & Monitoring:

Premedication: I actually took this case over from the overnight doctor, so I can't recall exactly what they had set up. Let's see... hmmm, they just gave it some hydro. I don't know why I'm the only one that uses so much dexmedetomdine/ketamine as a premed. Am I missing something?
Induction: Good ol' milky smoove propofol!
Maintenance: All we have is isoflurane. Do you even need to ask?
Analgesia: I did a local block. Well, I ordered it, but the techs for some reason aren't always comfortable administering it, even though it's the easiest injection possible (okay fine, SC is slightly less technical). Anyway, it's not clear to me if it was given or not, lemme go check–okay, she said she did give it. Phew!
IV Fluids: The usual whatever mL/kg/hr that's recommended by the smart people at the famous vet schools.
Monitoring: HR, RR, BP, SpO2, EtCO2, all that crap.

Surgical Procedure:

1. Approach:
A rather hesitant ventral midline incision was made from xiphoid to pubis using a #10 scalpel blade. Subcutaneous tissues were bleeding kind of a lot and pulling back into the fat like little bastards. The linea alba was just nowhere to be found until it magically popped out after I made an incision just off midline. When I got into the peritoneum, it was basically just a massive wad of falciform fat. This thing was so fat. I felt like I was churning butter with my hands trying to get through that thing.

2. Exploratory Findings:
Anyway, I made it in. Semi-systematic exploration of the abdominal cavity revealed a segment of jejunum that was oh so gn-gn-gnarly looking! Distended! Firm! I don't even know what color it was, sort of like a chartreuse-mahogany or something. Not good. I barely touched it, and it kinda collapsed like when Clark Griswald cut into that turkey in Christmas Vacation. I swear, out popped 14 plastic green army men. They were arranged in what looked like a military formation. No other abnormalities were noted in the abdomen, because the surgeon was actively clenching off his body's urge to sh— his pants.

3. Resection & Anastomosis:
The affected segment of bowel was blessed with holy water and an offering was made to whoever the patron saint of Veterinary Medicine is (Saint Herriot?). And then that terrifying piece of intestinal death was exteriorized and isolated using laparotomy sponges. I would love to say that I used Doyen intestinal forceps, but literally everything fell apart with gentle traction, and so once I found the "cut ends" floating around in the abdomen, everything had leaked out anyway and I didn't need any occlusion. The anesthetist made an emergency call to my therapist and we had a good "Greg's a big boy now" chat. An end-to-end anastomosis was performed using a panicked mix of simple and continuous (and a few fairly creative) sutures. A leak test was laughed off as ridiculously out-of-date and then done anyway. Mesenteric vessels were ligated using 3-0 PDS.

4. Abdominal Closure:
The abdomen was lavaged for three consecutive hours with warm sterile saline. This part was fairly relaxing, until the patient's blood pressure tanked. Then the body wall was rushed closed with 0 (or 2-0 I can't remember I was so stressed) PDS in a simple-ish continuous pattern. Subcutaneous tissues were closed with 3-0 monocryl in more of a slapdash pattern, and the skin was stapled the heck closed before I passed out from terror.

Foreign Material Description:

A set of plastic green army men.

Estimated Blood Loss:

Me? Or the patient?

Complications:

Delayed sleep schedule, adrenal fatigue, weeks to months of excess therapy, and one or two hazy IPAs as a coping mechanism.

Prognosis:

We'll have to see. On the one hand, it was the horrific display of my low self-confidence (lowest since that Virology Final sophomore year of vet school). But on the other hand, the dog is miraculously doing well and the owners were actually happy and showed gratitude to everyone in the clinic, which felt really special and meaningful and like it was worth going through all the stress and fear.

So... fair?

Signature:

Greg Bishop, DVM