Abstract
BACKGROUNDLaparoscopic transvaginal natural orifice specimen extraction (NOSE) procedure, as one of sub-surgical procedure selections of NOSE, has been well discussed recently. Although most studies argued receiving better post-surgical outcomes than laparoscopic right hemi-colonic radical resection, disadvantages of laparoscopic transvaginal NOSE have seldom been reported. Herein, we reported a case with an overwhelming infection after laparoscopic transvaginal NOSE, even leading a sudden cardiac arrest, and also performed a review of the literature of NOSE, in hopes of expending experience with NOSE for every general surgeon.CASE PRESENTATIONA 78-year-old female patient was diagnosis with ascending colon carcinoma (cT3N0M0). After pre-surgical preparation, a laparoscopic transvaginal NOSE was performed. At the 1st day post-surgery, a septic shock was manifested, with an acute cardiac failure. An intensive care unit therapy was given immediately, including anti-inflammatory therapy, anti-shock therapy, cardiac functional supporting therapy. At the 2nd day post-surgery, there was a sudden cardiac arrest. A cardiac emergency treatment was immediately given to her, following a comprehensive therapy. After a supporting treatment, this patient was discharged from our department at 12 days post-surgically, with a normal manifestation of blood pressure level, breath rate, heart rate, body temperature, white blood cell count, et al. However, a complaint of intermittent precordial pain still existed when discharging from our department. She was transferred to cardiovascular medicine department for a further treatment on cardiac function then. After another 18 days treatment, she left from hospital.CONCLUSIONSConsidering many clinical trials on NOSE with positive clinical outcomes, NOSE was recommended to an optional surgical treatment for gastrointestinal carcinoma. However, this case report reminders general surgeons that post-surgical complications to NOSE, some are even fatal, still has possibility to come out. A thorough evaluation pre-operationally and an appropriate therapy post-operationally are crucial and inevitable.
“The Rhythm of Cancer” – Unexpected Autopsy Finding in a Patient with Gastric Ulceration
