Our Summary

This research paper discusses the case of a 78-year-old woman who had a high blood pressure crisis, a type of heart attack, and fluid in her lungs. Additionally, she was experiencing abdominal pain, constipation, and vomiting. Upon examination, her abdomen was significantly swollen. During a colonoscopy, a large abnormal growth was found 20 cm from the rectum. A biopsy revealed it was a specific type of pre-cancerous growth.

The patient underwent surgery to explore her abdomen and remove a part of her colon under a specific type of anesthesia known as thoracic combined spinal epidural anesthesia. This type of anesthesia was used as it provides pain relief during and after surgery. The patient was classified as ASA5, which means she was a critical patient at risk of death.

Current guidelines recommend using regional anesthesia (which numbs a specific area) instead of general anesthesia (which puts you to sleep) for elderly patients with severe health conditions. This is the first reported case in Palestine of a critically ill patient undergoing abdominal surgery using this specific type of anesthesia. The surgery was successful.

FAQs

  1. What is the significance of the patient being classified as ASA5 according to the American Society of Anesthesiologists physical status?
  2. Why was regional anaesthesia chosen over general anaesthesia for this elderly patient?
  3. How was the thoracic combined spinal epidural anaesthesia administered in this case?

Doctor’s Tip

A helpful tip that a doctor might tell a patient about sigmoidectomy is to follow the post-operative instructions carefully, including taking prescribed pain medication, eating a healthy diet, and avoiding strenuous activities. It is also important to attend follow-up appointments with your healthcare provider to monitor your recovery progress and address any concerns. Additionally, maintaining good hygiene around the surgical site can help prevent infection and promote healing.

Suitable For

Patients who are typically recommended sigmoidectomy are those who have a variety of conditions such as colorectal cancer, inflammatory bowel disease, diverticulitis, or severe cases of diverticulosis. Additionally, patients with precancerous polyps or other abnormalities in the sigmoid colon may also be recommended for sigmoidectomy. In the case mentioned above, the patient had a fungating mass lesion with high-grade dysplasia, which necessitated the surgical removal of the sigmoid colon.

Timeline

Before sigmoidectomy:

  • Patient presented to hospital with hypertensive emergency, non-ST elevation myocardial infarction, and pulmonary effusion
  • Experienced abdominal pain, constipation, and vomiting
  • Significant abdominal distention noted during examination
  • Colonoscopy revealed a fungating mass lesion 20 cm from the anal verge
  • Biopsy showed intramucosal adenoma within tubulovillous adenoma with high-grade dysplasia

After sigmoidectomy:

  • Underwent exploratory laparoscopy and laparotomy (sigmoidectomy, colostomy) under thoracic combined spinal epidural anaesthesia at T9-T10 interspinous space
  • Patient classified as ASA5 according to American Society of Anesthesiologists physical status
  • Successfully underwent surgery under regional anaesthesia
  • First reported case in Palestine of an ASA5 patient undergoing abdominal surgery under thoracic combined spinal epidural anaesthesia

What to Ask Your Doctor

  1. What is the purpose of a sigmoidectomy and why is it recommended for my condition?
  2. What are the potential risks and complications associated with sigmoidectomy surgery?
  3. What is the expected recovery time and post-operative care after sigmoidectomy?
  4. Are there any alternative treatment options to sigmoidectomy that I should consider?
  5. Will I need a colostomy after the sigmoidectomy procedure?
  6. How will my pain be managed during and after the sigmoidectomy surgery?
  7. Are there any specific dietary or lifestyle changes I should make before or after the sigmoidectomy surgery?
  8. How often will I need follow-up appointments after the sigmoidectomy surgery?
  9. What is the success rate of sigmoidectomy surgery for patients with my condition?
  10. Are there any specific precautions I should take before and after the sigmoidectomy surgery?

Reference

Authors: Maree SA, Jadou A, Manasra MR, Temezeh K, Ibedo F. Journal: SAGE Open Med Case Rep. 2024 Dec 6;12:2050313X241282183. doi: 10.1177/2050313X241282183. eCollection 2024. PMID: 39650168