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D&CJune 21, 2012
CRPresented to PCP with pain on defecation and hematochezia
Colonoscopy - Anal mass - Squamous cell carcinoma
PMedHx: DM, HTN, peripheral neuropathy, gout, anxiety
Prostate CA - 45 Gy + seeds
PSurgHx:Knee, hip, and spinal surgery
Imaging - possible inguinal and sacral nodal involvement.
Referred to MCV for treatment
In clinic: Dehydrated and unable to control stool.
Admitted for resuscitation
CR - Events
30 May - Diverting transverse end colostomy
06 June - Septic. Taken to OR for exploration.
Ischemic right colon with leak from staple line
Ostomy from distal limb patent
20 June - Trach
Complication: Ischemic right colon, Sepsis
Procedure: Diverting end transverse colostomy
Primary Diagnosis: Anal SCC
Analysis of Complication
Was this avoidable? Yes
Would avoiding the complication change the outcome? Yes
What factors contributed to the complication?
Redundant sigmoid, large omentum - Anatomy.
Learning Points
Ensure the anatomy is clear
If things don’t open up, reassess the situation