General Surgery DnC Sundeep Guliani

HS 53 yo male screening colonoscopy -> endoscopically unresectable 2.5 cm ascending colon polyp PMH/PSH: Unremarkable Laparoscopic Right hemicolectomy – Stapled side-to-side anastamosis – EBL: 30 cc

Cont POD 0-2 – Hgb 14->10-> 8, HD stable, Abd distention, No blood requirement POD 6-7 – Temp > CT: Ileus, blood around spleen, liver, no fluid collections or free air POD 8 – Resp distress, ICU tx -> PE CT neg – eventual intubation, hypotension – Bld cx: GNR, unremarkable urinalysis/cxr

Cont Re-exploration – No leak or abscess – Anastamosis intact – 2 L blood removed Cx: Ecoli in blod, psuedomonas from intra-op cx Path: Tubulovillous adenoma with focal intramucosal adenocarcinoma (Tis) Currently on general diet, home today or tomorrow

Retrospective study sought to define the accuracy of CT scan to diagnose early postoperative LGI leaks in patients who were reoperated within 30 days for clinical and/or radiologic evidence of a leak and in whom a leak was confirmed during re-operation

Cont 70 pts over 8 years with leaks – 41 pts who had CT scans within 72 hrs of re- operation but were explored on grounds of subsequent clinical detioration were analyzed – 29 were re-operated on based on clinical grounds alone Colon surgery most common

32 CT scans were performed within 24 hours of re-operation Leak, high prob, low prob, no leak Preoperative CT findings showed leak or high probability of leak 47% No real difference in small bowel VS large bowel

Cont While all patients receiving CTs were symptomatic, the mean interval until reoperation was 7.3±4.4 days in patients who underwent CT studies compared to 4.5± 2.4 days in patients who were reoperated without CTs (p=0.003). Study cautioned CT scans being used as justification for the absence of a leak

Teaching points/Issues Re-exploration CT okay doesn’t mean patient is okay