Damage control surgery by transverse colon perforation: case report

Abstract

Obstruction and perforation due to colorectal cancer represent challenging matters in terms of diagnosis, life-saving strategies, obstruction resolution and oncologic challenge. The outcomes of these different resections when performed in acute clinical situations remain substantially unexplored. Case report: 65 years old diabetic and obese female, with abdominal pain accompanied by the absence of channeling of flatus and bowel movements as well as countless vomiting of low intestinal content, wich is why its refer to the emergency of the IAHULA, Merida Venezuela. Physical examination: tachycardic, tachypneic, with, HR: 130 TA: 90/60, FR: 28m oxygen saturation 89%. Abdomen distended, diminished hydro aerial sounds, painful on palpation, with voluntary muscular defense. An emergency laparotomy show: general fecal peritonitis, perforations of the transverse colon, stenosing sigmoid tumor. For this reason, phase 1 damage control surgery was performed by transversectomy + placement of proximal and distal threads, requiring phase II in an intensive care unit, ventilatory support and vasopressor drugs. Phase III was planned in 48 to 72 hours for probable complete left colectomy, however, the patient died after 18 hours of postoperative. Discussion: damage control surgery has been considered an appropriate approach to the treatment of critically ill patients with severe intra-abdominal sepsis. Conclusion: Abdominal sepsis and a septic shock are both possible as a critical scenarios in patients with perforation and obstruction of the colon secondary tumors and carcinomas, for that reason it is important to know which patient can be selected to a damage control surgery in orden to improve the morbimortality.