Case Review:

45 y.o. post colonoscopy with 8mm. sigmoid polypectomy. Discharged several hours later with normal vital signs and no complaints. Next morning, increasing abdominal pain and rectal bleeding. Presents to E.R. Abdominal X-Ray shows pneumoperitoneum. Sigmoid perforation found and Loop Colostomy performed. Prolapse of distal limb and closure 3 months later.

 

Case Review:

44 y.o. with severe pneumonia and respiratory failure. Requires intubation and R.I.G. (radiographically implaced gastrostomy). Subsequently improves. Feeding tube removed but presents 17 months later with abdominal pain. C.T. reveals small metallic foreign body in stomach. EGD reveals retained T-Fastener with suture and is removed.

 

Case Review:

55 y.o. develops cancer of the esophagus. C.T. reveals possible communication of the tumor with an adjacent cystic mass. The patient has dysphagia, is endoscoped and dilated with progressive balloon dilators. The endoscopist notes retroperitoneal structures and realizes there is a perforation. Patient undergoes prolonged hospital course before dying from the cancer.

 

Case Review:

75 y.o. with aspiration pneumonia, respiratory failure and requires P.E.G feeding tube. Tube functions well initially but after transfer to rehab facility patient develops fever, tachycardia , left shift, treated with multiple antibiotics for unknown source of fever. 10 days later she is transferred to acute care facility and abdominal C.T. reveals large abscess. X-lap reveals a dislodged feeding tube with peritonitis secondary to large amount of liquid feedings.

 

Case Review:

75 y.o. with acute sigmoid diverticulosis which resolves with antibiotics and conservative treatment. Undergoes difficult colonoscopy 2 months later only to sigmoid colon. Has increasing abdominal pain immediately post procedure and is sent to E.R. C.T. shows free air. Undergoes Hartman Procedure with closure 3 months later. A large mouthed diverticulum was found to be perforated at X-lap.

 

Case Review:

73 y.o. with hip fracture. Post surgery and during rehab was given strong analgesics. Patient had a history of constipation. Patient developed severe abdominal pain 1 month later with signs of generalized peritonitis. X-lap revealed perforated stercoral ulcer of the sigmoid colon. Resection and temporary colostomy performed.

Case Review:
22 y.o. college student with Ulcerative Colitis. Gastroenterologist ordered Imuran and Pepcid. The pharmacy mislabeled the bottles and the patient took 2 Imuran/day and one Pepcid/day for 5 days. She developed Ludwig's angina and sued the pharmacy. It was determined that the dose of Imuran, although twice the amount ordered, was still within therapeutic limits.

Case Review:
36 y.o. on Augmentin for 1 week. Develops severe watery diarrhea 7-10 times per day. Seen in E.R. with tachycardia, elevated WBC with left shift, temp. 103 degrees. Given Lomotil, stool ordered for C&S, O&P, C.Diff., but not done. Patient given more Lomotil and sent home. Presents 3 days later with Toxic Megacolon unresponve to medical therapy and has total colectomy for Pseudomembranous Enterocolitis.