Complications vignettes

Question 1

39-year-old woman 3 years s/p (“status post”) Billroth II for perforated gastric ulcer presents with intermittent upper abdominal pain relieved by a large amount of bilious vomiting

Answer 1

Afferent limb syndrome

Question 2

POD #2 s/p open gastric bypass for morbid obesity, patient becomes tachypneic and short of breath. Sats 5 86%, ABG PO2 5 52, CO25 30,EKGnormal, chest x-ray normal

Answer 2

Pulmonary embolus

Question 3

During placement of a central line, a 42-year-old woman with breast cancer becomes acutely short of breath. Her breath sounds are decreased on the ipsilateral side of the line placement

Answer 3

Pneumothorax

Question 4

A 77-year-old man s/p laparoscopic cholecystomy returns to the clinic with a palpable lower abdominal mass, confusion, and weak urine stream

Answer 4

Urinary retention

Question 5

56-year-old woman s/p gastrojejunostomy for duodenal trauma (pyloric exclusion) now presents 1 year post op with tachycardia, dizziness, and abdominalpaina after eating

Answer 5

Dumping syndrome

Question 6

21-year-old s/p GSW to abdomen with small bowel resections develops tachycardia, fever, and green bilious wound drainage

Answer 6

Anastomotic leak and enterocutaneous fistula

Question 7

28-year-old man with traumaticsuperficial arterial occlusion for
7 hours develops severe
calf pain with passive
dorsiflexion of foot,foot paresthesias, decreased foot/toe movement, and palpablepulsea after successful bypass procedure

Answer 7

Calf compartment syndrome

Question 8

Twoweekss/p modified radical mastectomy a 45-year-old woman with
infiltrating ductal cancer of the right breast returns to the clinic and complains of her right scapula “sticking out

Answer 8

Winged scapula due to injury to the long thoracic nerve

Question 9

28-year-old woman s/p spinal anesthesia for a tubal ligation develops back pain, fever, and increased WBCs on POD #3

Answer 9

Epidural abscess

Question 10

80-year-old man s/p appendectomy with fever, right-sided face pain, and elevated WBCs

Answer 10

Parotitis

Question 11

18-year-old man POD #1 with fever, wound pain, bronze-colored drainage, and crepitus

Answer 11

Clostridial wound infection

Question 12

65-year-old smoker with severe COPD treated intermittently with antibiotics, prednisone, and albuterol undergoes
a colectomy. Postop the patient develops hypotension, dizziness, and fever with normal hematocrit and abdominal exam

Answer 12

Adrenal crisis—adrenal insuffciency

Question 13

38-year-old female diabetic with cellulitis on broad- spectrum antibiotics for
2 weeks develops fever, massive diarrhea, and abdominal pain

Answer 13

Clostridial difficile colitis

Question 14

59-year-old female smoker POD #4 from AAA repair develops hypotension and tachycardia with multiple PVCs

Answer 14

Myocardial infarction

Question 15

67-year-old male POD #5 s/p AAA repair with bloody diarrhea

Answer 15

Ischemic colitis

Question 16

48-year-old woman undergoes a hysterectomy and develops an acute increase in end tidal CO2 in the middle of the operation and then develops a very high fever, cardiac arrhythmia, acidosis, and hyperkalemia

Answer 16

Malignant hyperthermia