Anastomotic Complications
15 results
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Perioperative- A 42-year-old man with a body mass index (BMI) of 34 has stricturing Crohn’s and will need to undergo an ileocecectomy. He smokes a half pack of cigarettes per day. He has previously failed azathioprine and 6-mercaptopurine (6-MP), and he is currently on infliximab and a prednisone taper. What modifiable risk factor would be the most helpful to mitigate to decrease his chances of postoperative infectious complications?
- A 45-year-old man is diagnosed with sigmoid colon cancer on screening colonoscopy. Staging workup shows no evidence of metastatic disease. Which of the following combinations, in addition to standard intravenous antibiotic prophylaxis, is recommended to decrease surgical site infection after segmental colectomy?
- Patients who require ultralow anterior resection with coloanal anastomosis may benefit from temporary diverting loop ileostomy to reduce the risk of
- A 55-year-old man undergoes a low anterior resection without diverting ileostomy for an T2N0M0 rectal cancer with anastomosis 5 cm from the anal verge. On postoperative day 10, he presents to the emergency department with low abdominal pain and bloating, decreased bowel function, urinary hesitancy, and low-grade fever. On examination, his heart rate is 90, blood pressure is 110/55 mmHg, and temperature is 100.5 °C. He has some localized low abdominal tenderness. His white blood cell count is 15. Computed tomography (CT) of the abdomen and pelvis with oral, intravenous (IV), and rectal contrast shows a 5-cm perianastomotic abscess with some stranding but no free air. What is the best next step in the management of this patient?
- A 77-year-old man has recently undergone a low anterior resection with diverting loop ileostomy for rectal cancer after total neoadjuvant therapy. His hospital course was routine, and he was sent home on postoperative day 4. The patient presents back to the clinic 3 weeks after the index operation. He reports urinary retention, pelvic pain, and bloating. You note an overall failure to thrive. Which test is the most likely to correctly diagnose this patient’s problem?
- A 65-year-old patient who underwent an open right colectomy develops a fever of 101.3 °F, tachycardia, and abdominal pain 7 days after the procedure. Bilious fluid is expressed through the midline incision. Computed tomography (CT) demonstrates a large ventral subfascial fluid collection, and a drain is placed with a daily output for 3 consecutive days more than 500 mL. His fever and tachycardia have resolved. The best next step in management is
- Benign Disease
- A 54-year-old woman with a history of endometriosis is referred to you for worsening constipation, bloating, and pelvic pain. She previously underwent a laparoscopic-assisted hysterectomy with bilateral salpingo-oophorectomy. You perform a colonoscopy and identify a stricture at the rectosigmoid; the rest of her colon was normal. Pelvic magenetic resonance imaging (MRI) shows irregular thickness with three large spiculated nodules that were hypointense on T1- and T2-weighted images, encasing 70% of the wall of the rectosigmoid, consistent with endometriosis. What is the best surgical option for this patient?
- A 39-year-old woman with a history of long-standing ulcerative colitis (UC) undergoes an elective total proctocolectomy and ileoanal pouch anal anastomosis (IPAA). Two months postoperatively, she reports a persistent low-grade fever, dyspareunia, vaginal air, and mucopurulent rectal drainage. A gastrografin pouch study demonstrates a pouch vaginal fistula. What is the most likely etiology?
- A 34-year-old woman undergoes total abdominal colectomy with an ileostomy for fulminant ulcerative colitis. She strongly desires to avoid a permanent stoma. She is counseled extensively regarding J pouch and she chooses to undergo completion proctectomy. After constructing a J-pouch, you find that the apex of the pouch does not reach the divided rectal cuff. Which is the most appropriate next step?
- Eight days after ileal-pouch anal anastomosis (IPAA) and diverting loop ileostomy, your patient presents to the emergency department with pelvic pain, low-grade fever, and purulent drainage per anus. The patient is hemodynamically stable with a white blood cell (WBC) count of 14. Intravenous (IV) antibiotics and fluids are initiated. Computed tomography (CT) with rectal contrast reveals a deep pelvic abscess with contrast extravastion into the cavity. What is the best next step in the management of this patient?
- A 30-year-old woman is status post total proctocolectomy, ileal J pouch-anal anastomosis and loop ileostomy for refractory ulcerative colitis two months ago. She now presents for follow-up to discuss elective takedown of her loop ileostomy. As part of her workup a gastrograffin enema is obtained (see figures). The best next step is
- A 65-year-old woman comes to the emergency department with progressively worsening constipation and abdominal pain over the past 3 months. She had a few mild attacks of diverticulitis. Her last colonoscopy was 2 years ago after her first episode of diverticulitis, and there were no concerns for malignancy. She is afebrile with normal vital signs; her last bowel movement was 3 days ago, and she has mostly left-sided abdominal pain. Computed tomography (CT) shows no free air or active inflammation but a significantly narrowed 8 cm length of sigmoid colon with upstream dilation of the colon, suggestive of a diverticular stricture (see figures). The best treatment option is
- Anorectal Disease
- Pelvic Floor
- Malignancy