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Case 49 

Case 49
Chapter:
Case 49
Author(s):

Alissa J. Walsh

, Otto C. Buchel

, Jane Collier

, and Simon P.L. Travis

DOI:
10.1093/med/9780199557899.003.49
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date: 21 August 2019

A 49-year-old female carer developed severe abdominal pain over the course of a fortnight, with diarrhoea, weight loss, and vomiting. She was admitted via the emergency department, where a CT scan showed intestinal obstruction, a stenosing tumour in the transverse colon, and liver metastases. She was taken to theatre, where an extended right hemicolectomy was performed, with resection of a gangrenous loop of small bowel. This was complicated by an anastomotic leak requiring further laparotomy and ileostomy, following which there was wound dehiscence and discharge through two enterocutaneous fistulas. Seventeen days after the initial admission, on a Friday, parenteral nutrition was requested urgently.

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