Complex Colorectal Surgery and Successful Re-exploration at Bombay Gastro & Cancer Institute, Bathinda
A 26-year-old female, a known case of sigmoid colon stricture, presented to the emergency department with severe abdominal pain, progressive abdominal distension, persistent vomiting, and acute intestinal obstruction.
Following clinical evaluation and CT imaging, the patient was diagnosed with obstructed sigmoid stricture and scheduled for emergency surgery.
Unexpected Intraoperative Findings
The patient underwent emergency surgery performed by Dr. Raman Garg, Consultant Surgical Gastroenterologist, Advanced GI, Laparoscopic & HPB Surgeon at Bombay Gastro & Cancer Institute, Bathinda.
During exploration, the operative findings were significantly more severe than anticipated.
Approximately 1 litre of purulent fluid was present throughout the abdominal cavity, confirming generalized purulent peritonitis. In addition to the sigmoid stricture, two microperforations of the transverse colon were identified.
Considering the extensive disease and intra-abdominal infection, the operative plan was modified. A Left Extended Hemicolectomy with Primary Colorectal Anastomosis was performed to remove all diseased bowel while restoring intestinal continuity in the same sitting.
A Rare Postoperative Complication
The patient initially recovered well. However, on the 6th postoperative day, she developed:
- Progressive abdominal distension.
- Severe upper abdominal pain.
- Recurrent vomiting.
An urgent CT scan demonstrated a grossly dilated stomach. Importantly, the colorectal anastomosis remained completely intact, with oral contrast passing freely up to the rectum and no evidence of an anastomotic leak.
Despite intensive conservative management, her symptoms failed to improve.
Successful Re-exploration
A decision was made for immediate re-exploration by Dr. Raman Garg.
During surgery, the stomach was found densely adherent to the retroperitoneum, resulting in a rare functional gastric outlet obstruction. A localized intra-abdominal pus collection was also identified.
The adhesions were meticulously released, the infected collection was drained, and a triluminal Freka® jejunal feeding tube was inserted to provide early enteral nutrition while simultaneously allowing gastric decompression.
Excellent Recovery
Following the second operation, the patient's recovery was steady and uneventful.
- Gastric function gradually returned to normal.
- Oral feeding was resumed successfully.
- No further postoperative complications occurred.
- Discharged on the 10th postoperative day on a normal oral diet in satisfactory condition.
Why This Case Is Important
This case presented multiple unexpected surgical challenges requiring careful intraoperative decision-making and advanced postoperative management.
What initially appeared to be a straightforward sigmoid colon stricture with intestinal obstruction was found to be generalized purulent peritonitis with transverse colon microperforations, necessitating a more extensive colorectal resection.
The subsequent development of functional gastric outlet obstruction caused by postoperative adhesions is an exceptionally rare complication after colorectal surgery. Prompt recognition, timely re-exploration, adhesiolysis, drainage of the localized infection, and nutritional support using a Freka® jejunal feeding tube resulted in an excellent clinical outcome.
This case demonstrates Dr. Raman Garg's expertise in managing highly complex colorectal emergencies, severe intra-abdominal sepsis, postoperative complications, and difficult reoperative gastrointestinal surgery.
Advanced Colorectal and Gastrointestinal Surgery by Dr. Raman Garg
Dr. Raman Garg is a leading Surgical Gastroenterologist in Bathinda, specializing in the treatment of colon diseases, rectal disorders, colorectal cancer, intestinal obstruction, inflammatory bowel disease, perforation peritonitis, emergency abdominal surgery, gastrointestinal cancers, liver and pancreatic diseases, gallbladder disorders, and advanced laparoscopic surgery.
His expertise includes complex colorectal resections, reoperative abdominal surgery, emergency gastrointestinal procedures, hepatopancreatobiliary (HPB) surgery, and minimally invasive gastrointestinal surgery.
Patients from Bathinda, Punjab, Haryana, Rajasthan, and neighbouring regions seek treatment from Dr. Raman Garg for both routine and highly complex gastrointestinal conditions.
Patient: 26-year-old Female
Diagnosis: Sigmoid Colon Stricture with Acute Intestinal Obstruction, Generalized Purulent Peritonitis, Transverse Colon Microperforations, and Postoperative Functional Gastric Outlet Obstruction due to Adhesions
Procedures Performed: Left Extended Hemicolectomy, Primary Colorectal Anastomosis, Re-exploration, Adhesiolysis, Drainage of Localized Intra-abdominal Pus Collection, and Triluminal Freka® Jejunal Feeding Tube Placement
Operating Surgeon: Dr. Raman Garg, Surgical Gastroenterologist, Advanced GI, Laparoscopic & HPB Surgeon, Bombay Gastro & Cancer Institute, Bathinda
Outcome: Successful management of a highly complex colorectal emergency with complete recovery, restoration of normal oral intake, and discharge on the 10th postoperative day.
About Dr. Raman Garg
Dr. Raman Garg is a Consultant Surgical Gastroenterologist, Advanced GI, Laparoscopic and HPB Surgeon at Bombay Gastro & Cancer Institute, Bathinda. He specializes in gastrointestinal cancer surgery, liver, pancreas and bile duct surgery, colorectal surgery, hernia surgery, upper GI surgery, emergency abdominal surgery, and advanced minimally invasive procedures.
Patient identity has been withheld to maintain confidentiality. This case is shared for educational purposes with appropriate consent and privacy safeguards.
