Thursday, July 8, 2010

Complex Diverticulitis




This is about as bad as it gets. I saw an elderly lady with a chief complaint of frequent urinary infections and passage of stool per her vagina. The images above demonstrate obvious colovesical and colouterine fistulae. The CT also demonstrated significant left ureteral obstruction at the level of the pelvic inlet. What ensued was a complex multi-specialist procedure involving a sigmoid resection, hysterectomy/oophorectomy, and ureteral stenting. Good stuff.

9 comments:

Anonymous said...

What part of the surgery did you handle? Any chance you can drop some arrows in future images to tell tell us nonclinicians what we're seeing, and the orientation?

Frank Drackman said...

Jeez Buckeye, the only thing more disgusting than a Recto-Vaginal fistula might be the Cavaliers "performance" against the Celtics, any Cleveland Indians/Browns Game, or a drunk Woody Hayes punching that Clemson Player for having the nerve to intercept a Big 10 QB...
Or Lebron taking his toys to the Big Apple...:(

Frank "SEC RULES" Drackman

Buckeye Surgeon said...

Anon-
I took out the colon. And "dropping arrows" onto an image, although a wonderful idea, is way beyond my paygrade. The images, alas, will have to remain somewhat esoteric until I figure out how to do fancy internet things like that. Thanks.

Anonymous said...

holy crap. i'm barely a 1st yr med student but this intrigues me soooo much, i just need to wield a scalpel like you Buckeye. we'll see. keep up the good work, and saving lives.

Kim said...

Whoah. Eat your fiber kids!!

rlbates said...

Wow!

Sergiu said...

Here's a nice article that might be worth reading

How Microbes Defend and Define Us

http://www.nytimes.com/2010/07/13/science/13micro.html?scp=1&sq=How%20Microbes%20Defend&st=cse

James said...

I was in the hospital for a little over a month last year (Sept 09) for a very bad case of Diverticulitus. I did my own internet homework to figure out that I had it a few years ago (Not that I suggest people diagnose themselves. I was just tired of getting sick.). Last summer after coming back from vacation I ate something that didn't agree with my diverticulitus (A chocolate bar who's name I won't say. Still can't look at them the same way, even though I used to love them.). That was early July, and I was laid up in bed all of July and August. Went to the hospital to get checked out and was told I had a fairly bad infection, and was given a battery of antibiotics to take, but they ended up stripping my stomach and making me unable to eat, or finish the last 4 days of the pills, even though I still felt horrible and REALLY wanted to finish them. A few weeks later, I was in the hospital. They tried IV antibiotics to get it under control, since I'm a heavy guy and I guess they only operate on big people as a last resort due to the added risks, but it didn't take either. So after being sick for about 10 weeks, I got scheduled for surgery. Was explained to me by the surgeon, whom even the other abdominal surgeon in the hospital said was the go to guy, that he would be taking out only the infected areas, which amounted to a few inches of bowel I was told. About a 2 hour operation. Four and a half hours later, they wheel me back out to my family in the recovery room and tell them that he had to remove my whole colon and, in his words, I had "One of the top three cases" he'd ever seen. And this is someone who does this regularly. The guy doing the gas told me that he saw my color improve the instant they took it out. The whole colon was infected, and it was abscessing towards my kidneys and spleen. The surgeon did manage to work it in such a way that I didn't end up with a colostomy bag. And he saved my life to boot. And, he was the only person who actually answered "Is this going to hurt?" honestly, when I asked him about them taking out my JP. (His answer - "Oh god yes!" And it did.") Took 50 staples to close the wound, of which I have pictures. And I needed a VAC wrap to close the wound after I had a blood clot form and hamper the healing. Moral of the story - Don't eat chocolate bars. :) lol

Anonymous said...

did the additional surgeons help? I like to do it all myself if possible.