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#quickcase. A mid-30s patient with #crohns has been on multiple biologics and noted to have a tight proximal sigmoid stricture. Dilation not helped. Also with anal stricture requiring multiple dilations. Remainder of colon looks good. How do you proceed?
#quickcase. Following TNT for a low rectal cancer that initially invaded seminal vesicles (see image), residual lumenal tumor exists but no more invasion of SV. What are your resecting?
#quickcase. Your mid 40s patient with history of two vaginal births is experiencing severe constipation and straining. Her defecography is shown. Biofeedback without change. Multiple laxatives with one BM every 2 weeks. Next steps?
#quickcase. Middle aged otherwise healthy female with colo-uterine fistula. No prior Crohns/ radiation/ cancer. Colonoscopy with diverticulosis and no prior -itis. CTE otherwise normal. Thoughts? Plans?
#quickcase. Following an endo anal advancement flap and subsequent episioproctotomy and reconstruction your mid 50s patient has a recurrent rectovaginal fistula. What now?
I don’t do airleaks test for right colectomy however, If I notice any leak during operation ı oversew it. #quickcase @ScottRSteeleMD
#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 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 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. 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. 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. On surveillance scope for a 51 patient with prior polyps, you see the following lesion in mid-rectum. Snare removal reveals t1 moderately differentiated cancer with positive deep margin. CT & MRI negative. CEA 3.3. How do you proceed?
#quickcase 72yo woman with fecal incontinence treated with SNM 5 years ago. Good results for the first 3 years. After that symptoms worsened progressively. No improvement after several reprogrammings. Battery still 25%. Sacral Rx shows as follows. What would you do?
#quickcase. You are referred a 27 yo patient after a lap appendectomy with pathology returning moderate grade NET, Ki-67 10% and 5 mitoses per HPF. Tumor margins 5 mm -as was located near cecal base. Metastatic work up negative. What do you recommend?
#quickcase. During a laparoscopic right colectomy for large adenoma of the appendix on a 34 yo female, you note the ovary appears as below. GYN is not available. What next?
#quickcase. You are asked to see a 57 yo diabetic obese patient with a deep post anal space abscess. Your approach is?
#quickcase. You see a mid-50s patient in clinic with air in urine and prior #UTI. Surgery in a few weeks. Abx til then? In the OR you don’t identify a fistula. Drain? Keep foley after? How long?
#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. On POD2 Following a lysis of adhesions and resection for bowel obstruction you notice green drainage from the midline wound. What’s next?
#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 you are asked to see a late 60s female with a prior resection mesh rectopexy with recurrent prolapse. MRI defecography shown. Approach?
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