Hand-over-hand method to evaluate small bowel in perforations or Trauma
•Control of contamination is an important priority. Essential observations must include the location of the injury, the number of injuries, the size of the rent, and the location on the mesenteric or antimesenteric border of the bowel. Obvious leakage must be controlled.
•The entire small bowel,from the ligament of Treitz tothe ileocecal valve, and the ascending, transverse, scending, and sigmoid colon need to be inspected.This is best achieved with the help of an assistant. Each segment is passed hand over hand and flipped to side between the surgeon and an assistant,with both people inspecting the same segment. If the
bowel is dropped, a fresh start from the igament of Treitz is essential. It is also important to conduct a complete evaluation of the antimesenteric and mesenteric border of the bowel, as well as the mesentery. An odd number of bowel enterotomies would prompt a second look for a missed injury.