Anastomotic Complications
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Anastomotic Complications
Anastomotic Complications
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 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?
- General Postoperative Complications
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
- Complications of the Pelvic Pouch
- Indications for Fecal Diversion
- Preoperative Evaluation in Colorectal Patients
- Impact of Postoperative Complications On Oncologic Outcomes
- Crohn’s Disease: Surgical Management
Ostomy Surgery (2022)- Malignancy
- Anastomotic Construction
- Ostomy Complications and Management
How to Manage and Prevent Complications- Rectovaginal Fistula
- Bowel Dysfunction Low Anterior Resection Syndrome
- Intestinal Stomas
- Endometriosis
- 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?
- 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
- Use of Bowel Preparation in Elective Colon and Rectal Surgery (2019)
- Large Bowel Obstruction
- About ASCRS Textbook of Colon and Rectal Surgery
- Optimizing Outcomes with Enhanced Recovery
- Surgical Management of Crohn's Disease (2020)
- Rectal Prolapse
- Anorectal Disease
- Clostridium difficile Infection
- Treatment of Rectal Prolapse (2017)
- Enhanced Recovery After Colon and Rectal Surgery from ASCRS and SAGES (2023)
- Ulcerative Colitis: Surgical Management
- Core Descriptor Sets for Rectal Prolapse Outcomes Research Using a Modified Delphi Consensus
- Radiation, Microscopic, and Ischemic Colitis
- Management of Rectal Cancer 2023 Supplement (2023)
- Bowel Transection and Anastomosis
- 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
- Rectal Prolapse, Perineal Repair (Perineal Rectosigmoidectomy: Altemeier Procedure)
- Pelvic Floor
- Management of Colonic Volvulus and Acute Colonic Pseudo-Obstruction (2021)