Gabriel Díaz (Gastrointestinal Surgery Specialist)
Xavier Morales (Gastrointestinal and Emergency Surgery Specialist)
Hospital Clínic, Barcelona, Spain
A 75 year old male patient with previous record of larynx carcinoma treated with radical surgery and tracheostomy visited the emergency room for suffering constipation and abdominal distention, a X-Ray (FIG. 1) showed a sigmoid volvulus that was successfully treated by colonoscopy.
After the first episode the patient had 2 additional readmissions due to a recurrent volvulus so surgical treatment was proposed. Anterograde lavage, sigmoidectomy by laparoscopy and primary anastomosis was accomplished without incidences.
On the 5th postoperative day the patient started with inferior gastrointestinal bleeding and fever, on physical examination there was no pain, blood test showed leucocytosis and high PCR levels, a X-Ray was performed (FIG. 2 – 3) revealed a pneumoperitoneum. With a high suspicion of anastomotic leak a laparoscopy was performed identifying a disruption of the anastomosis and secondary peritonitis, the treatment was completed by a Hartmann’s procedure, abdominal cavity lavage was made with iodine solution and the rectal stump was reinforced using separated knots of a non absorbable poly filament suture.
The patient developed a prolonged ileus requiring nutritional support that solved with conservative treatment, intra abdominal collections were ruled out by CT Scan. The patient is waiting for re-evaluation and study for transit reconstruction.