Detaillierte Beitrags-Information
| Beitragstitel | Toxic Megacolon with Perforation as a Severe Complication after Sacro-Iliacal Hemipelvectomy |
|---|---|
| Beitragscode | P104 |
| Autoren | |
| Präsentationsform | Poster |
| Themengebiete |
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| Abstract |
Purpose Hemipelvectomies are technically demanding and challenge both the surgeon as well as the patient to meet the objectives. Many complications may arise, which requires a respective interdisciplinary institutional set-up and the awareness of treating physicians that the unexpected can be handled in the team. Herein, we report on a patient who developed a toxic megacolon with subsequent perforation. Method A 63 year-old man developed a sacro-iliacal metastasis of a non-seminomatous germcell tumor 16 years after initial diagnosis and treatment. He underwent chemotherapy according to the TIP protocol and showed a good response, but not complete regression. It was then decided to remove the tumor completely to render the patient disease-free. Iamging showed that the tumor had a 7cm soft tissue lesion over the posterior aspect of the ilium, destroyed the PIS, passed the SI-joint and involved the ipsilateral hemisacrum. A internal hemipelvectomy was performed with an osteotomy starting at the anterior notch through the ilium, as well as involving the ipislateral hemisacrum with parts of the contralateral sacrum between S2 and S4. A reconstruction with a cage, rods and pedicle screws was followed. The patient received iv antibiotics for 48h. Initial postoperative course was uneventful, with the patient being mobilized on 3 postoperative day (POD). Results On POD 5 the patient developed some discomfort and a CT scan showed a distended abdomen. On POD 6, the clostridium difficile antigen and toxin were found. He was treated and monitored accordingly and remained hemodynamically stable until POD15 when he became unstable and free abdominal air was diagnosed. He underwent an explorative laparotomy with hemicolectomy and abscess removal, an ileostoma was done. One day later, a further laparotomy was performed with resection of the duodenum and removal of hematoma was done. With an abdominal VAC. One day later, a third revision was performed with then closure of the fascias, to then another 5 days thereafter, to ultimately close the wound completely. Five wekks after index surgery, the patient was leaving the hospital for rahbilitation. Conclusion Perforation of a toxic megacolon is a life threatening complication after internal hemipelvectomy. Whereas transitory bowel paralysis is often the case after these type of surgeries, one needs to be aware of this complication and actively search for it. |