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Retained colon in the subcutaneous fat after colostomy reversal

  • Meghan K. Arndts EMAIL logo
Published/Copyright: October 26, 2020
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 121 Issue 2

A 58-year-old woman presented to a general surgery center in 2019 with a painful lump and intermittent drainage. She had undergone a Hartmann procedure in 2008 for diverticulitis, followed by sigmoid colectomy with reversal of colostomy 6 months later. In 2011, she developed a painful lump near her old colostomy site. She noted that the lump waxed and waned in size; it would periodically become red and drain fluid. In 2015, she underwent exploratory laparotomy with closure of an enterocutaneous fistula, but this did not resolve her symptoms. After she presented to our office with continued pain and intermittent drainage from the lump, a CT scan was performed, which demonstrated bowel in the subcutaneous fat, no hernia, and no connection to intra-abdominal bowel (image A). The patient underwent surgical excision, and intraoperative findings and pathology were consistent with retained colon containing inspissated stool (image B). The patient’s symptoms resolved after this procedure.

This case illustrates the importance of obtaining a thorough history and performing a complete physical examination,1 supplemented by the patient’s prior health records. In the era of electronic medical records and telehealth, the importance of history and physical examination are often overlooked.2,3,4 This patient had seen several surgeons and her primary care physician on multiple occasions, receiving various diagnoses from sebaceous cyst to hernia. After a thorough history, physical examination, and review of old CT scans, the patient was able to receive an accurate diagnosis prior to surgery and an issue that had been troubling her for 11 years was resolved.

Corresponding author: Meghan K. Arndts, DO, Adams Health Network, 1617 Woodedge Ave Springfield, Ohio 45504-1363, USA, E-mail:

References

1. Centor, RM, Geha, R, Manesh, R. The pursuit of diagnostic excellence. JAMA Netw Open. 2019;2(12):e1918040. https://doi.org/10.1001/jamanetworkopen.2019.18040.Search in Google Scholar

2. Asif, T, Mohiuddin, A, Hasan, B, Pauly, RR. Importance of thorough physical examination: a lost art. Cureus. 2017;9(5):e1212. https://doi.org/10.7759/cureus.1212.Search in Google Scholar

3. Carr, S. Reexamining the physical exam. Improve Dx Newsletter. 2020;7(1):1-5. Available at https://www.improvediagnosis.org/wp-content/uploads/2020/01/Vol.-7-Issue-1.pdf. Accessed September 30, 2020.Search in Google Scholar

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Received: 2020-04-22
Accepted: 2020-06-04
Published Online: 2020-10-26

© 2021 Meghan K. Arndts, published by De Gruyter, Berlin/Boston

This work is licensed under the Creative Commons Attribution 4.0 International License.

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https://doi.org/10.7556/jaoa.2020.153
Creative Commons
BY 4.0

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. The language of race and ethnicity in academic medical publishing
  4. Behavioral Health
  5. Original Article
  6. Associations between stress, anxiety, depression, and emotional intelligence among osteopathic medical students
  7. Cardiopulmonary Medicine
  8. Clinical Practice
  9. Straight back syndrome as a clue to diagnosing asymptomatic congenital valvular heart disease and limiting the risk of weightlifting
  10. Innovations
  11. Review Article
  12. Toward the use of medical scent detection dogs for COVID-19 screening
  13. Medical Education
  14. Original Article
  15. Osteopathic students and graduates matching into pathology residency, 2011–2020
  16. Medical Education
  17. Special Communication
  18. Diversity in osteopathic medical school admissions and the COMPASS program
  19. Medical Education
  20. Commentary
  21. The history of medical education: a commentary on race
  22. Musculoskeletal Medicine and Pain
  23. Original Article
  24. Effect of occipitoatlantal decompression on cerebral blood flow dynamics as evaluated by Doppler ultrasonography
  25. Neuromusculoskeletal Medicine (OMT)
  26. Review Article
  27. Osteopathic manipulative treatment and the Spanish flu: a historical literature review
  28. Obstetrics and Gynecology
  29. Original Article
  30. Untangling the roots of the West Virginia opioid crisis: relationships in adolescent pregnancy, drug misuse, and future outcomes
  31. Public Health and Primary Care
  32. Original Article
  33. The seroprevalence of SARS-CoV-2 in a rural southwest community
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  35. Original Article
  36. Evaluating disease outbreaks with syndromic surveillance using medical student clinical rotation patient encounter logs
  37. Public Health and Primary Care
  38. Original Article
  39. Red blood cell distribution width and outcome in trauma patients
  40. Public Health and Primary Care
  41. Review Article
  42. SGLT2 inhibitors: a narrative review of efficacy and safety
  43. Clinical Images
  44. Retained colon in the subcutaneous fat after colostomy reversal
  45. Gonococcal arthritis
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