OAGS Case of the Month

Hosted by OAGS President Dr. Ravinder Singh.

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Scroll down for previous case outcome summaries.

Unable to see the case below? Click here.    Conversation/results: download

Dr. Singh will share his previous case outcome here after a new one is posted each month.

MARCH 2024 - Case Outcome (posted April 9, 2024)

82 M had presented with Acute Cholecystitis. He had an attempted laparoscopic cholecystectomy but there was significant inflammation and thus a cholecystostomy was placed (JP drain). The drain subsequently stopped draining, and the patient despite being stable was not improving. He complained of persistent RUQ pain. Repeat CT POD#10 showed active intra-mural hemorrhage in the gallbladder wall with a surrounding hematoma, and another intra-abdominal hematoma. Decision was then to transfer to HPB surgeon for further management. Subsequently he had an open sub-total cholecystectomy.
Poll Results: download

Original Case Query:
82 Male with a PMHx of Atrial Fibrillation on anticoagulation, and a pacemaker. Presents with upper abdominal pain, nausea, and vomiting. This has been periodic over the last several months but worse in the last several days. Otherwise stable. Blood work ok. CT scan is as follows: sludge in the gallbladder; no biliary dilatation; LFTs normal.

What would be your management?
a. Antibiotics alone and reassess need for cholecystectomy at a later date
b. Antibiotics and Cholecystostomy (after NOAC is held for 48-72h)
c. Antibiotics and Cholecystectomy (after NOAC is held for 48-72h)
d. Send to HPB

Case outcome will be shared with next month’s case!

APRIL 2024 - Case Outcome (to be posted in May)
Original Case Query:
A 16 year old female with history of obesity presented with several day history of abdominal pain. CT showed acute appendicitis. She was taken to the OR and she had significant inflammation in the RLQ with sigmoid and ileum adhered to what was presumed to be the area of the appendix. She had a small abscess that was drained but further dissection was impossible. A JP drain was placed and she was kept on ABX. Folllow-up CT revealed a decrease in inflammation and no abscess; the drain was removed and she was booked for an interval appendectomy. Intra-operatively, she had less inflammation but had dense adhesions. The appendix was removed. Pathology revealed a T4N0 NET (NeuroEndocrine Tumour) at the tip 8mm in size. Of course she was M0 based on 2 CT scans. What would you do next?
1. PET scan
2. NET Metabolic work-up
3. Nothing
4. Refer to Neuroendocrine Specialty Clinic
5. Right Hemicolectomy