Sunday, May 27, 2007
karma kicks in
As I finish up my Sunday morning rounds, I run into one of our internal medicine colleagues who wants me to see a woman with, wouldn't you know it, an obstructing left colon lesion. I suppose it's the general surgery gods smiling down upon me for draining the rectal abscess yesterday. Eight days of symptoms. Lingered at an outside rural hospital for the past couple of days. Left lower quadrant tenderness. WBC 14,ooo. CT showing air fluid levels in dilated colon from cecum to descending/sigmoid junction. The GI guys don't do colonic stenting here, so she is likely to end up with an end colostomy. Is there anyone who would routinely perform subtotal colectomy for obstructing left colon lesions? I have in cases where the cecum appears dusky/ischemic with multiple serosal tears. Also, anyone comfortable doing on-table lavage and primary anastomosis in these difficult situations?
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recently did a non starter where the lady had total obstruction of the left with pressure necrosis of the cecum due to dilatation. did damage control, but regret not doing subtotal.
what's a non-starter?
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