Large Bowel Obstruction
11 results
1 - 11
Malignancy- A 67-year-old man who has never had colonoscopy presented to the emergency room reporting abdominal pain, distention, constipation, and blood per rectum for the past 2 days. He says his bowel movements are thin in caliber. Computed tomography (CT) of abdomen and pelvis shows a large mass in the mid rectum with proximal colonic distention. Magnetic resonance imaging (MRI) of the pelvis with rectal cancer protocol shows a mid-rectal T4N2M0 lesion. The mass is not amendable to endoscopic placement of stent due to angulation. The best next step is
- A 76-year-old man with a history of left-sided colon cancer presents with a 2-day history of obstipation, increasing abominal distension, and cramping. He has progressed on third-line chemotherapy. Cross-sectional imaging shows normal caliber small bowel, dilated cecum, ascending, and transverse colon with a mass in the distal descending colon. He has bilobar liver disease and multiple thoracic metastases. He is hemodynamically stable. What is the best option for revieving the obstruction?
- A 56-year-old obese man with locally advanced distal rectal cancer is treated with total neoadjuvant chemoradiation therapy. His is a 45-pack-per-year smoker. Restaging reveals no sign of metastasis. Magnetic resonance imaging (MRI) rectal protocol reveals partial clinical response and flexible sigmoidsociopy that shows a 3-cm tumor involving the sphincteric complex. What is the best surgical approach in his care?
- A 43-year-old woman with familial adenomatous polyposis (FAP) and history of total proctocolectomy and ileal pouch anal anastomosis presents with an 9 x 8 x 6 cm desmoid tumor at the root of the small-bowel mesentery causing obstruction. What is the best next treatment of choice is?
- A 37-year-old female patient with no prior colonoscopy and without chronic medical conditions undergoes an urgent laparotomy for a high-grade large bowel obstruction. At surgery, an obstructing rectosigmoid mass is discovered, with significant distention of the colon proximal to the mass. The cecum demonstrates significant distention with several partial-thickness serosal tears secondary to overdistention. The patient’s vital signs are stable, the patient’s small intestine and rectum are not distended, and there is no gross contamination. The best surgical option is
- A 78-year-old woman with coronary artery disease and congestive heart failure presents with symptoms of large bowel obstruction. Computed tomography (CT) shows a large obstructing descending colon mass with numerous hepatic and pulmonary lesions suggestive of metastatic disease. There is no evidence of bowel perforation or ischemia. Flexible endoscopy shows a large near complete obstructing carcinoma in the descending colon. Which of the following is the most appropriate next step?
- A 62-year-old woman is found to have a large near-obstructing sigmoid cancer on colonoscopy; biopsy returns as adenocarcinoma. Preoperative staging includes a carcinoembryonic antigen (CEA) level of 8 ng/mL, and imaging shows a few prominent lymph nodes near the sigmoid lesion. She is referred for surgical management. Frozen section on peritoneal nodules found near the lesion return as adenocarcinoma, and oncological resection is completed. Which of the following is the best determinant of the prognosis for this patient?
- A 50-year-old man presents with abdominal pain. Colonoscopy with biopsy revealed a large B cell lymphoma in the ascending colon. Staging workup reveals a nonobstructing mass in the ascending colon without evidence of metastatic or multifocal disease. The best next step is
- Perioperative
- Benign Disease
- A 50-year-old man presents to the emergency department with the sudden onset of periumbilical pain, abdominal distention and vomiting. The right lower abdominal quadrant is tender to palpation. Computed tomography (CT) results are below. The most appropriate treatment is
- A 65-year-old man who underwent a recent colostomy for fecal incontinence presents to your office with a symptomatic parastomal hernia, despite multiple appliance changes. What is the best step for definitive treatment?