Ostomy Complications and Management
4 results
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Benign Disease- A 56-year-old healthy male patient presents to the emergency room because he has been experiencing left-sided abdominal pain for the past 4 days. He reports localized tenderness on examination. Screening colonoscopy performed 3 years prior was normal. His vital signs are 98% SpO2, heart rate of 112, blood pressure of 120/76, and respiratory rate of 14. White blood cell count is 16, and other lab results are normal. You obtain a computed tomography (CT) of the abdomen and pelvis, which shows the following abcesses: He was placed on IV antibiotics but failed to progress. Interventional radiology is unable to safely place a drain. What is the best next step?
- A 43-year-old woman presents to the emergency room with 24 hours of nausea, vomiting, and bloating. She has history of Crohn’s disease with no prior surgery and is currently not taking any medications. She smokes one pack of cigarettes per day. Computed tomography (CT) is obtained (see figure below). Magnetic resonance enterography (MRE) shows mucosal edema and hyperenhancement. She is treated with intravenous (IV) fluid resuscitation, bowel rest, and nasogastric decompression. Inpatient colonoscopy performed 4 days later demonstrates inflamed ileal mucosa and narrowed lumen. What is the best next step in this patient’s management?
- A 56-year-old patient with a BMI of 41 is transferred to your hospital after undergoing emergent sigmoid colectomy with colostomy for perforated diverticulitis. On postoperative day 3 she is found to have sloughed the distal portion of the ostomy due to necrosis and retraction of the stoma (see figure below). Bedside evaluation demonstrates ischemia that extends proximal to the fascia. The patient is currently hemodynamically stable. Computed tomography angiogram of the abdomen and pelvis demonstrates patency of the celiac and superior mesenteric arteries and no visualization of the the inferior mesenteric artery. What is the best next step in management?
- A 55-year-old man with obesity has completed neoadjuvant chemoradiation therapy for CT3 N2 M0 distal rectal cancer. During his posttreatment evaluation, he is found to have a partial clinical response and is offered a low anterior resection. His total mesorectal excision is completed uneventfully; however, the mesentery to his terminal ileum is thickened and foreshortened causing difficulty in getting the bowel to reach the abdominal wall in the ideal location. The best option for fecal diversion in this patient is