Patient Requires Complete Colon Removal Following Delayed Surgical Intervention

Case Overview

This case involves a 65-year-old female with a complicated past history who was diagnosed with a colon adenocarcinoma. The patient had the adenocarcinoma removed laparoscopically and her post-surgical margins were clean. While in the hospital, the patient experienced an elevated white blood cell count as well as abdominal pain. Several imaging studies were conducted on the patient. The results demonstrated free air in the abdomen but the patient was not taken back for exploration. 18 days after the initial surgery, the patient returned to the hospital with severe abdominal pain and night sweats. She returned to the operating room and it was determined that the patient’s entire colon required removal. It was alleged that the delay in post-surgical treatment caused the patient’s unfortunate prognosis.

Questions to the General Surgery expert and their responses

How often do you operate on patients with adenocarcinoma of the colon?

I operate on patients with colon cancer weekly. Generally, at a minimum, I handle three cases per week involving colon cancer.

When are post-operative imaging studies recommended and what are absolute indications for a RTOR?

The decision to conduct postoperative imaging and return to the operating room are clinical judgments that are difficult to state in absolute terms. Usually, there are clinical indicators that are present to dictate whether imaging or operation is necessary. These signs include vital signs, trending of labs, exam findings, other indicators that there is something that requires further intervention. Persistent fever, up-trending of the WBC count, worsening physical exam signs, failure to progress after surgery, etc. are all signs.

About the expert

This expert has over 15 years of experience in the field of general and colorectal surgery. He earned his BS from Muhlenberg College, his MSEd from the University of Southern California and his MD from Hahnemann University School of Medicine. He completed residencies in general and colorectal surgery and a fellowship in colorectal surgery research at the University of Southern California. He is board certified in general surgery and colon and rectal surgery and is a fellow of the American Society of Colon and Rectal Surgeons. He previously served as the Medical Director of peri-operative services and the Chief of surgery at LAC+USC Medical Center and as an Assistant Professor of colorectal surgery at the University of Southern California. This expert currently serves as an Associate Professor of colorectal surgery and as the Program Director of the colorectal residency program at a prominent medical school in California. He is also the Chief of colorectal surgery at a university-affiliated medical center.