ABSTRACT
CHALLENGING CASE A laparoscopic left hemicolectomy was performed for an asymptomatic 2.0 cm sigmoid adenocarcinoma found on screening colonoscopy. Due to her previous three cesarean sections and abdominal hysterectomy with bilateral oopherectomy, she required extensive lysis of adhesions in order to mobilize the left colon. The procedure was uneventful and the patient was discharged home on postoperative day number three. On follow-up at 10 days, patient was doing well except for a new complaint of left “side pain” rated as a 3 out of 10. Management was expectant and patient was scheduled for a follow-up visit. She presented to the emergency room one week later with significant left flank pain and a fever of 102.1. Her WBC count was 21,000 and serum creatinine was 1.2 (preop 0.9). A CT scan of the abdomen and pelvis with and without intravenous contrast was ordered and left hydroureteronephrosis was seen down to the level of the mid-ureter.
