Global cerebral ischaemic injury in the setting of post caecal resection for colorectal carcinoma
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Kerry Anne Golley, a 35-year-old woman with intellectual disability, autism, and epilepsy, presented with recurrent vomiting between December 2011 and February 2012, requiring multiple ED visits and hospital admissions. She was placed on a semi-urgent waiting list for gastroscopy and colonoscopy. Following admission with vomiting, constipation, and seizures, she underwent left hemicolectomy for colorectal cancer at Albury Base Hospital. She suffered a suspected seizure post-operatively, failed to regain consciousness, and was transferred to St Vincent's Hospital where imaging revealed brain swelling and herniation. She died from global cerebral ischaemic injury. The cause of cerebral ischaemia was not definitively identified but may have been related to hypoxia from ongoing seizure activity in the post-operative period. Clinical lessons include the importance of urgent investigation of recurrent vomiting in young patients, careful post-operative monitoring in patients with epilepsy, and rapid recognition and management of altered consciousness post-operatively.
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Specialties
general practiceemergency medicinesurgerycolorectal surgeryintensive careneurologyneurosurgeryforensic medicine
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