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Bowel Perforation with Delayed Contamination

ID: exh73697b
This exhibit features two large sagittal views of the chest and upper abdomen comparing the immediate post-operative condition with the condition several days later following the removal of the mediastinal drainage tube. Each image shows the median sternotomy wound closed. The first image illustrates the immediate post-operative condition. In this view the drainage tube is shown filling the small perforation of the transverse colon permitting only a small amount of leakage from this perforation site. Also, the surrounding scar tissue is forming a dam to effectively isolate the leaking intestinal fluid. Furthermore, the colon is relatively empty due to the pre-operative fasting and the slowing of digestion caused by the anesthesia.rnrnThe second image illustrates the subsequent condition several days later. At this point the tube has been removed and, since the patient has been eating and the digestive system reactivated, there is much more material within the bowel. This combination of factors shows a much more active drainage of intestinal contents through the perforation site out into the abdomen.
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