Early outcomes after open total colon resection for haemorrhagic pan-colonic diverticulosis: Report of a case and review of literature; Department of Surgery, Adult Hospital, University Teaching Hospitals, Lusaka, Zambia

Abstract

Total colon resection is usually performed to treat or prevent diseases that affect a large part of right and left colons and that could not been answerable to medications alone. Patients are then referrals from gastroenterologists, who had been treating them for a certain time. A part from cancer patients, who are sent quickly to surgeons upon diagnosis, other conditions include: complicated polyposis, inflammatory bowel disease (ulcerative colitis, Crohn disease) and Hirschprung disease affecting the whole colon. Pan-colonic diverticulosis disease is rare in Sub-Saharan African settings; hence is also very rare an open total colectomy aiming to treat it. A 80 year-old man was referred to our surgical unit from a gastro-entomologist for medically unanswerable pan colonic haemorrhagic diverticulosis. Furthermore, the patient has a well-known long standing hypertension with chronic heart ischemic lesions a type 2 diabetes Mellitus stabilized medically. The report is aiming to share the perioperative features mainly the early outcomes postoperatively when reviewing relate literature. The case served as a topic for a grand round interdepartmental topic at the University Teaching Hospitals, Lusaka and deserved contribution from the Internal Medicine Units where he had been hospitalised for anaemia in a cardiac unit. Then the patient was followed for bleeding colonic diverticulosis by the Gastro-enterology unit without success. He was finally referred to our Surgical Unit where one stage Open Total Colon Resection was indicated, performed and managed with the contribution of units of endoscopy, Intensive Care, Anesthesia, Cardiovascular and Biomecal laboratory as well as Medical Imaging and Nutrition support departments. After managing type II unavoidable complications, the patient was discharged and was reviewed in out-patient in an excellent status of health with quasi normal defecation habits, not pale and well hydrated, of course continuing taking his comorbidity drugs. Conclusion: One step pan-colectomy with site-end one layered extra-mucosal ileo-rectal anastomosis is a safe procedure in extensive colonic surgical disease of a stabilised patient.