#quickcase

#quickcase you are asked to see an ICU consult for abdominal pain, diarrhea and WBC 37k. P 110s SBP100s. #cdiff positive and has been on vanco and flagyl. Tender but no peritonitis. CT below. Now what?

#quickcase. A young male sustains a gunshot wound to left buttock with exit out right thigh. Flex sig with min blood and no identifiable wound. VS P105 BP 120/60s. Abdomen mild distension, no peritonitis. CT as shown. What now?

#quickcase. A mid 30s patient with CD with prior ileocolic resection with stapled side to side anastomosis has a symptomatic recurrence at anastomosis with recurrent obstructions despite ustekinumab . Previously on two other anti-TNFs. How do you proceed?

#quickcase. Mid 60s patient on screening colonoscopy undergoes #EMR resection of this polyp at distal ascending colon. Pathology with focus of adenocarcinoma amongst TVA with HGD. Margins cannot be assessed with piecemeal. What next?

#quickcase. Mid 40s female with #constipation and straining and bloating. Transit studies prolonged while on multiple laxatives. Defecography shown. Now what?

#quickcase following admission for Acute onset abdominal pain and CT as shown, intraoperative findings demonstrate 100cm of bowel as pictured. What is your longer term plan for underlying cause?

#quickcase you are asked to see a mid-50s patient with AML s/p #chemo with increasing right abdominal pain. Moderate tenderness on exam. HR 90s BP 110/79. Wbc<1. CT with cecal/right pneumatosis as shown. Has been on abx for 24 hours. How do you manage?

#quickcase. You are asked to see a patient with prior TPC with EI for Crohns and has persistent intermittent peristomal lesions as shown. Failed steroid injections- what are your next steps?

#quickcase #colorectalsurgery during a left colectomy you are mobilizing the splenic flexure and note brisk bleeding from both the retroperitoneum and capsule - what now?

#quickcase. On routine screening colonoscopy with retroflexion you see the following lesion. How do you proceed?

#quickcase during a right colectomy you have an air leak at the ileocolic anastomosis. How do you proceed with the situation on the operation? Do you air leak for a right?

#quickcase #colorectalsurgery. You are asked to see a young patient with history of #ulcerativecolitis s/p #IPAA with urgency, anal pain and bleeding. Scope as shown as you enter. Rest of pouch normal. What next?

#quickcase. Following a prior proctectomy for stage 3 rectal cancer, your patient has isolated PET positive recurrence as shown. They had received neoadjuvant chemorads (TNT). How do you proceed?

#quickcase mid 50s otherwise healthy non smoking patient with history of colitis of unknown origin with splenic flexure stricture and residual inflammation in distal transverse colon. Failed dilation and unable to clear right side. What now?

#quickcase #colorectalsurgery POD 1 from lap right for Cecal volvulus (left) your 82 yo pt begins to have multiple bloody BM. He is in lovenox for a mechanical valve. HR 90s (on beta blockers) BP 100s, hgb 8 with 2U. Additionally CT demonstrates right image. How do you proceed?

#quickcase. You are seeing a patient with a history of repeated ischemic colitis for colectomy. Do you specifically evaluate the blood vessels or collateral circulation? If so, how? If not, why not?

#quickcase mid 20s patient with recurrent #pilonidal sinus. Drains, painful: no abscess. Only I&D in the past. How do you proceed?

#quickcase you are asked to see a patient with a low lying GIST with upper sphincter invasion. Has had 3 months of imatinib with mild decrease size. What now?

#quickcase. Mid 40s female with prior posterior rectopexy for rectal prolapse still with obstructive defecation symptoms and now defecography with intussusception as shown. Now what?

#quickcase 1 week post-segmental small bowel resection for #SBO your patient has increasing pain, fevers, ileus and rising WBC. You give IVF and abx and CT shown. HR 110s and SBP 100s. How do proceed?