This case involves an elderly female patient in Massachusetts who presented to the hospital with lower back pain, and subsequently underwent a CT scan and colonoscopy that showed a suspicious mass. The patient presented to the hospital a few days later for bowel resection surgery to treat the mass. Notes from the procedure indicate that the surgery was successful. A few hours after the procedure, however, the patient developed abdominal distention. Tests revealed a severed ureter, as well as acute renal failure. She was treated and sent home, but returned a few days later with multiple complications, including sepsis and a heart attack, and had to be hospitalized. The patient languished in the ICU for several months before dying.
Question(s) For Expert Witness
- 1.Have you treated a patient that presents with a similar mass?
- 2.Have you seen a ureteral injury following a colectomy?
Expert Witness Response E-005305
I have treated patients in the past with a similar mass, which I assume in this case was a colorectal cancer. If the cecal mass had been biopsy proven to be a colorectal cancer (whether pre-op or intra-op via frozen section), standard of care would dictate that 5 cm margins are requires and that a formal right hemicolectomy would likely be performed. If the pathology of the cecal mass was unknown at the time of operative exploration, a biopsy with frozen section should have been done to confirm whether or not it was malignant. I have seen ureteral injuries after colon resection as well as other pelvic operations. It is best to try and avoid injury if possible, either by stenting them pre-op or identifying them and protecting them pre-op. If a patient develops worsening abdominal pain soon in the postoperative period, a ureteral injury would have to be a significant concern. Diagnosis could be made via a CT urogram or intravenous pyleogram. If a drain was left, the fluid could be sent for creatinine. If elevated it would be highly suspicious for a ureteral injury. The ideal treatment is primary repair over a stent if the defect is small, or possibly reimplantation into the bladder.