Anastomotic Complications
12 results
1 - 12
Perioperative- A 56-year-old man undergoes a low anterior resection after neoadjuvant chemoradiation for a T3N0M0 rectal cancer located 9 cm from the anal verge. Eight days later, he presents to the emergency department with mild abdominal pain and a temperature of 102.2°F (39°C). Laboratory results are significant for a white blood cell count of 14,000/µL (14×109/L). Computed tomography of the abdomen and pelvis shows pneumoperitoneum with contrast extravasation into the pelvis. Abdominal examination shows focal peritonitis in the left lower quadrant. Intraoperative findings demonstrate a 3-mm anastomotic disruption anteriorly. In addition to abdominal washout, what is the best surgical option for this patient?
- A 56-year-old otherwise healthy man underwent an elective laparoscopic sigmoid resection for diverticular disease 5 days ago has worsening abdominal pain, fever, and chills. On examination, his temperature is 102.2°F (39°C), pulse 120 beats/min, and blood pressure 85/58 mm Hg, and his abdomen is markedly tender in the bilateral lower quadrants with rebound and guarding. What is the best next step in management?
- A 45-year-old man recently underwent a low anterior resection with coloanal anastomosis for a tumor located 3 cm from the anal verge. In this patient, which preventive measure would be most effective in reducing postoperative septic complication following an anastomotic leak?
- A 42-year-old woman underwent an open right colectomy 4 days ago. Her surgery required an extensive adhesiolysis. She has mild nausea and anorexia, complaining of lower abdominal discomfort. She is tender to palpation in the bilateral lower abdominal quadrants. She has a temperature of 101.1°F (38.4°C), a heart rate of 98 beats/min, and a blood pressure of 110/50 mm Hg; her white blood cell count is 14,000/μL. The best next step in management is:
- A 67-year-old man undergoes sigmoid colon resection for diverticulitis. He complains of progressive constipation and increasing abdominal distention. Endoscopic images are shown. What is the most appropriate treatment?
- Malignancy
- A 65-year-old woman with stage IV colon cancer treated with neoadjuvant chemotherapy presents for emergency surgery for a perforation while receiving chemotherapy. Which of the following regimens will have the highest risk for anastomotic leak?
- A 62-year-old man with abdominal pain and distention presents to the emergency room. Computed tomography of the abdomen and pelvis demonstrates an obstructing mass in the upper sigmoid colon with a single right hepatic metastatic lesion. The cecum measures 8 cm in diameter, and the small bowel is decompressed. What is the best next step in treatment?
- Benign Disease
- A 60-year-old woman is admitted to the hospital with lower abdominal pain and computed tomography findings shown in the Figure. After treatment with bowel rest and intravenous antibiotics for 5 days, she remains hemodynamically stable, but her leukocytosis worsens. What is the next best step in management?
- A 28-year-old man with a history of ulcerative colitis undergoes a total proctocolectomy with stapled ileal pouch–anal anastomosis. Six months after surgery, he presents with urgency, increased stool frequency, and bloody bowel movements. Endoscopic examination findings are shown (Figure A and B). What is the best next step in management?
- A 35-year-old man with ulcerative colitis underwent an ileal pouch–anal anastomosis. Eight weeks after surgery, contrast enema and pouchoscopy demonstrate a normal pouch and a patent anastomosis. No leakage from the pouch was noted on radiography. He underwent an uneventful ileostomy takedown. He initially did well but 6 weeks postoperatively he presents with pelvic pain, fevers, and increased pouch output. Computed tomography of the abdomen and pelvis reveals a pelvic abscess high in the pelvis with a normal pouch–anal anastomosis. An image-guided percutaneous drain is placed and the patient is treated with antibiotics. A sinogram 6 weeks later demonstrates a persistent fistula to the pouch. What is the appropriate management for this patient?
- Pelvic Floor
- A 75-year-old woman with chronic rectal prolapse wishes to discuss surgical treatment planning. She has prolapsing tissue with defecation, which is lifestyle limiting due to bleeding, fecal smearing, and pain. On physical examination, she has a 1.5-cm segment of circumferential prolapsing rectal mucosa with a focal anterior ulcer, no rectocele, and moderate baseline tone. She is frail, with a medical history significant for coronary artery disease after stent placement, receives dual antiplatelet therapy, and has a caretaker to assist with daily activities. What is the best surgical approach for repair of this patient’s prolapse?
- An 18-year-old woman with a lifelong history of constipation requiring daily enema use presents to your office. Anorectal manometry cannot elicit a rectoanal inhibitory reflex. On contrast enema, the rectum is dilated down to the internal sphincter without a visible transition zone. Full-thickness biopsies taken of the rectum just proximal to the dentate line shows aganglionosis and hypertrophic nerve trunks. The biopsy specimen taken approximately 2 cm above the internal sphincter shows normal ganglion cells. What is the best next step in management?