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Colon cancer with a colostomy bag

RVD, 51 y/o ,male, Filipino, OFW (Oversea Filipino Workers)

Medical History:
Oct. 30,2017 : Ultrasound of Kidney/Urinary bladder: Normal but with enlarged prostate seen
Nov. 1,2017: MRI of the pelvis- Muitiple diverticula throughout the rectum with focal diverticulitis.
Severe lobulated thickening of the visualized sigmoid colon and rectum
Nov. 7,2017 : Ultrasound of whole abdomen done showed Gall bladder stones and Fatty Liver.

Nov. 20,2017 : Went to Sanad Hospital, Riyadh for lower abdominal pain, flatulence, bloating, anal pain since 2 months. It is associated with bloody stools and weight loss of about 8 kgs.
Physical Examination: Patient is oriented, conscious and alert.
Vital signs: Temp: 37*C heart rate: 96/min BP: 120/80 mm Hg Oxygen saturation: 99%
Chest: Clear CVS: normal rhythm
Abdomen: soft
Laboratory results: WBC :6 Neutrophils: 67.2% HB: 9.1g/dl Platelet: 429 Stool analysis: positive for blood
CEA ( carcino embryonic antigen). 591.4 (very high)

Hospital Course:
Patient admitted in the Day Surgery Unit for Colonoscopy which showed the following:
Anus: multiple polyps
Rectum: mass extending from 10cm from anal verge to up to 18 cms and there is small polyp less than 5mm, which was removed from 25 cm from anal verge. Sample sent for Histopathology.
Result: descending/Transverse/Ascending colon- NORMAL cecum - NORMAL
He was discharged on a stable condition. No take home medications.

Nov.23.2017 : CT scan of abdomen and pelvis with oral, rectal and IV contrast: Severe lobulated thickening of sigmoid colon and rectum with extensive diverticulosis
Nov.26,2017 : Biopsy done
Specimen: rectal mass from the anal verge, colonoscopic biopsy- Result showed superficial polypoid fragments of tubulovillous adenoma with high grade dysplasia

Specimen: small polyp 25cm from the anal verge,colonoscopic biopsy

Result: Adenomatous polyp with high grade dysplasia

Dec.4,2017: Admitted at Sanad Hospital and underwent abdominoperineal resection under general anesthesia on Dec. 5, 2017. Blood transfusion of 2 units was done due to haemoglobin of 6.5g/dl which rose to 8.8g/dl. He was discharged with colostomy bag. Discharge medications were Clexane 40 mg
injection once daily for 1 month; augmentin tab 1 gm every 12 hrs for 1 week; pantoprazole 40 mg once a day for 1 month; Adol 1gm every 6 hrs. for 2 weeks
Dec. 14, 2017: Biopsy result of rectum and anus abdominoperineal resection specimen:
Result: High grade mucinous carcinoma with lympho vascular and perineural invasions
Dec.28, 2017: follow up done and was referred to medical oncology for chemotherapy. But the patient went home to the Philippines and refused to undergo chemotherapy.

Seen the patient at The farm at San Benito. He is pale, weak, sad looking with colostomy bag. He wants to just feel good by taking anything to boost his immune system. I recommended Bio-Normalizer.
Started on him one sachet at bedtime which he continuously took before going to Quirino Hospital for consult with a general surgeon. He was advised to have a colonogram to check the location of the end portion of the distal part colon but it was not seen. So, the colostomy could not be brought back to the
abdominal cavity. He just continued to take BN at 1 sachet every 3 days due to financial constraint. Now he puts up a pizza parlor business. He claimed to feel normal even in the presence of his colostomy bag.


- From Dr Radi Apostol's case