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