case 1
28 male patient presented to me with an acute surgical abdomen with hemodynamic instability following a blunt abdominal trauma , resuscitated and sent to OR , intra operative findings , gangrenous sigmoid , gangrenous distal ileum , questionable viability of the rest of the small bowel .....no injury to liver or spleen .
options of treatments :resection of the gangrenous segments with :
1-ileo-ileal anastomosis and end sigmoid colostomy .
2-colo-rectal anastomosis with protecting proximal ileostomy .
3-abdominal coloectomy and resection of the gangrenous ileum and end ileostomy .
4-abdominal coloectomy and resection of the gangrenous ileum and ileorectal anastomosis .
5-ileostomy and colostomy
32 years old male patient presented to ER with sepsis and picture of intestinal obstruction , acute renal failure , and unstable vital signs , x-rays show distended large and small bowel , spot diagnosis:
left colon cancer causing intestinal obstruction with early sepsis due trans-location of bacteria :
resuscitated with iv fluid and given iv antibiotic and planned for surgery .
intra operrative diagnosis was : obstructing sigmoid cancer with distended small and large bowel ...there was no liver mets.
left hemicolectmy was done with end colostomy (Hartmanns) .
post operative : the patient general condition improved , renal failure reversed and sepsis subsided .
biopsy :mod. differentiated adenocarcinoma T3N1
professional diagnosis : hereditary colon cancer needs follow up and family screening
case 2
