Complications of Surgery of Aortic aneurysm

Q) A 68 year old man undergoes repair of infra renal aortic aneurysm. On 2nd POD he has abdominal pain, bloody diarrhea and tachycardia. BP is 120/70. Abdomen is mildly distended and tender especially in the left lower quadrant.

How will you proceed

a) Send stool for clostridium and spores

b) CT Abdomen

c) Exploratory laparotomy

d) Higher antibiotics

Ans b 

Get a contrast CT Abdomen as bowel ischemia is a likely diagnosis 

Incidence of bowel ischemia after repair of aortic aneurysm is around 2-6%. It is because of loss of inferior mesenteric artery artery at the time of surgery and inadequate colonic collaterals. 

Spores and clostridium difficle diarrhea occurs after prolonged antibiotic use. Also there is no bloody diarrhea in it.

Exploratory laparotomy will be required after CT Shows full thickness gangrene and not before

Antibiotic escalation will not help at this stage.

 

Retroperitonuem tumor

Q) A 42 year old lady undergoes exploration for a retroperitoneum mass. In OT it is suspected that this is a liposarcoma. Which of the following is  not true about liposarcoma? ( Some MRCS Questions

a) Liposarcoma is the most common variant of sarcomas

b) They have a  pseudocapsule

c) They can grow quite large before producing symptoms

d) They are locally invasive and do not metastatize

Electrolytes

Q) A 50 year old male undergoes pancreatectomy for Carcinoma head of pancreas. His pre op Hb was 9.2g% and during surgery he received 5 units of PRBC. In the post op period on the 2nd day he develops ECG changes. Work up is done for Myocardial Ischemia which is negative. What is the most common  cause of ECG changes here

a) Hyponatremia

b) Hyperkalemia