Our Summary

This paper talks about a rare case where a 23-year-old man was seriously injured after surgery. The man had a surgical procedure to treat a twisted sigmoid (a part of the large intestine), which involved making a new connection between two sections of his gut and creating a temporary opening in his belly. A week after surgery, he developed a pocket of pus in his abdomen. Doctors attempted to remove the pus with a needle, guided by an ultrasound scan. However, this caused an injury to a blood vessel (the inferior epigastric artery) which led to severe internal bleeding and a large blood clot in his abdomen. Doctors had to perform another surgery to stop the bleeding and remove the blood clot. After this, the patient’s condition stabilized and he was able to go home.

FAQs

  1. What is a sigmoidectomy and why was it performed on the 23-year-old male?
  2. What complications can arise following a sigmoidectomy?
  3. How is a bleeding artery identified and treated after a sigmoidectomy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about sigmoidectomy is to watch for any signs of excessive bleeding or infection after the surgery. It is important to report any unusual symptoms, such as abdominal pain, distension, or a drop in hemoglobin levels, to your healthcare provider immediately. Early detection and treatment of complications can help prevent serious complications and ensure a successful recovery.

Suitable For

Patients who are typically recommended sigmoidectomy include those with:

  1. Sigmoid volvulus: This is a condition where the sigmoid colon twists on itself, leading to obstruction and potential ischemia. Sigmoidectomy may be recommended to treat this condition and prevent recurrence.

  2. Colorectal cancer: Patients with cancer of the sigmoid colon may undergo sigmoidectomy as part of their treatment plan, especially if the tumor is localized to this area.

  3. Diverticulitis: In cases of severe diverticulitis that do not respond to conservative treatment, sigmoidectomy may be recommended to remove the affected portion of the colon.

  4. Inflammatory bowel disease: Patients with severe ulcerative colitis or Crohn’s disease affecting the sigmoid colon may require sigmoidectomy to improve symptoms and prevent complications.

  5. Chronic constipation: In some cases, patients with chronic constipation that does not respond to other treatments may undergo sigmoidectomy to improve bowel function.

Overall, the decision to recommend sigmoidectomy for a patient will depend on their specific condition, symptoms, and overall health status, and should be made in consultation with a healthcare provider.

Timeline

Before sigmoidectomy:

  • Patient experiences symptoms of sigmoid volvulus, such as abdominal pain, bloating, constipation, and vomiting.
  • Diagnosis is made through physical examination, imaging studies (such as CT scan or X-ray), and sigmoidoscopy.
  • Surgery is recommended as the treatment of choice for sigmoid volvulus.
  • Patient undergoes sigmoidectomy, end-to-end colorectal anastomosis, and loop ileostomy to relieve the obstruction.

After sigmoidectomy:

  • Patient develops intra-abdominal pus collection one week post-surgery, which is treated with ultrasound-guided aspiration.
  • Patient experiences abdominal distension, pain, and a significant drop in hemoglobin post-aspiration.
  • Imaging reveals active bleeding from a branch of the inferior epigastric artery, leading to a massive intra-abdominal hematoma.
  • Hematoma is evacuated, and the bleeding artery is ligated to control the hemorrhage.
  • Patient stabilizes postoperatively with no further drop in hemoglobin and is discharged from the hospital.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with sigmoidectomy?
  2. How will my recovery process look like after the surgery?
  3. What steps will be taken to monitor for any potential complications post-surgery?
  4. How common is injury to the inferior epigastric artery during sigmoidectomy?
  5. What are the symptoms of a potential complication like intra-abdominal pus collection or hematoma post-surgery?
  6. How will such complications be diagnosed and treated if they arise?
  7. What is the likelihood of needing additional procedures or interventions if complications occur?
  8. How can I best prepare for the surgery to minimize the risk of complications?
  9. Are there any specific signs or symptoms I should watch out for post-surgery that may indicate a problem with the healing process?
  10. How long should I expect to be in the hospital after sigmoidectomy and what will my follow-up care look like?

Reference

Authors: Gaur NK, Shaikh O, Chilaka S, Vijayakumar C, Kumbhar U. Journal: Cureus. 2021 May 29;13(5):e15315. doi: 10.7759/cureus.15315. PMID: 34221764