1. D&C June 21, 2012

2. CR Presented 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

3. 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

4. Complication: Ischemic right colon, Sepsis Procedure: Diverting end transverse colostomy Primary Diagnosis: Anal SCC

5. 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.

6. Learning Points Ensure the anatomy is clear If things don’t open up, reassess the situation