Odder and odder: Elderly severe COPD, recent CABG (coronary artery bypass), anxiety, etc. with napkin ring low rectal lesion probable metastatic bladder ca on Path. As late as one year ago, he was still having frequent repeat cystoscopies and resection of superficial bladder cancers. Apparently, he has had Chemo or Radiation though also in past year--once again no records available right now.
Previous R hemicolectomy for polyps that couldn't be reached by scope. No recent abdominal surgery (last at least 2011 and was probably an incisional hernia repair--don't have that op report).
Decided to do sigmoid colostomy with mucous fistula, but when I got in there he had 2 upper abdominal abscesses, 1 in each upper quadrant--the right one appeared of typically GI source and was densely adherent to abdominal wall and several small bowel loops, the left one was much larger, contained thin yellow purulent fluid and was not attached to anything. I wondered if these were hernia mesh problems.
His retroperitoneum was densely fibrotic and the intestines were stuck to this retroperitoneal process.
Unfortunately, our Pathologist only works here Weds and Thursdays now, so no frozen available and I hadn't anticipated needing one.
A quick exam of the rectal lesion revealed no obvious attachment to bladder, but after this long operation, I didn't really think resecting this would be a good idea.
I could only get the distal transverse colon up as my colostomy because of the retroperitoneal fibrosis.
Today, the Pathologist called and stated there is cancer in the abscess cavity walls which most resembles breast cancer (Indian file cells). He is doing special stains. I suspect the retroperitoneal fibrosis is the same thing.