General Surgery Expert Discusses Internal Injuries Following Botched Bowel Resection

Case Overview

This case involves an elderly female patient in Massachusetts who presented to the hospital with lower back pain, and subsequently underwent a CT scan and colonoscopy that showed a suspicious mass. The patient presented to the hospital a few days later for bowel resection surgery to treat the mass. Notes from the procedure indicate that the surgery was successful. A few hours after the procedure, however, the patient developed abdominal distention. Tests revealed a severed ureter, as well as acute renal failure. She was treated and sent home, but returned a few days later with multiple complications, including sepsis and a heart attack, and had to be hospitalized. The patient languished in the ICU for several months before dying.

Questions to the General Surgery expert and their responses

Have you treated a patient that presents with a similar mass?

I have treated patients in the past with a similar mass, which I assume in this case was a colorectal cancer. If the cecal mass had been biopsy proven to be a colorectal cancer (whether pre-op or intra-op via frozen section), standard of care would dictate that 5 cm margins are required and that a formal right hemicolectomy would likely be performed. If the pathology of the cecal mass was unknown at the time of operative exploration, a biopsy with frozen section should have been done to confirm whether or not it was malignant.

Have you seen a ureteral injury following a colectomy?

I have seen ureteral injuries after colon resection as well as other pelvic operations. It is best to try and avoid injury if possible, either by stenting them pre-op or identifying them and protecting them pre-op. If a patient develops worsening abdominal pain soon in the postoperative period, a ureteral injury would have to be a significant concern. Diagnosis could be made via a CT urogram or intravenous pyelogram. If a drain was left, the fluid could be sent for creatinine. If elevated it would be highly suspicious for a ureteral injury. The ideal treatment is primary repair over a stent if the defect is small, or possibly reimplantation into the bladder.

About the expert

This qualified expert specializes in general, gastrointestinal, and laparascopic surgery. His clinical interests include GI motility, gastroesophageal reflux disease, stomach cancer, esophageal cancer, and colon cancer. He is board certified in Surgery and ICU Care, and heads the Division of General Surgery at his institution. He has also pursued several grant funded research projects and has authored more than 100 publications in his field.

E-005305

Specialties:

General Surgery