1. A 57-year-old female underwent a hemicolectomy with double barrel stoma for tumors found in her descending colon during a colonoscopy. 2. She was discharged with medications including antibiotics, antihypertensives, and omeprazole for reflux. Her antihypertensive was changed from amlodipine to felodipine due to side effects. 3. She was counseled on preparing for a follow up colonoscopy, including restrictions on her diet before the procedure.

1. HEMICOLECTOMY WITH DOUBLE
BARREL STOMA
KAVITHA SATHASIVAN
05/07/2012

2. • 47 yr old female was admitted to 3B on 18/06/12 for
colonoscopy scheduled on 19/06/12 to rule out any
possibilities of cancer after having altered bowel condition
(diarrhea and constipation) a/w vomiting 6 months ago.
• Colonoscopy result - tumours 30 cm from anal verge nearly
obstruct the lumen
• Exploratory Laparatomy with sigmoid colectomy with stoma
and HARTMANN'S procedure on 20/06/12
• Discharged on 27/06/12 with medication and TCA on
24/07/12 for colonoscopy.

3. • Name : JN
• Age : 57 yo
• Gender : Female
• Race : Malay
• Height : 148cm
• Weight : 56kg (18/06/12)
• BMI : 25.57kg/m2

4. • Electively admitted for colonoscopy
(19/06/2012 )

6. •Hx of breast abscess -> around 20yrs ago, had
surgery, told not cancer.
•Bronchial asthma
-On prophylaxis (MDI Budesonide & MDI Salbutamol)
-Last attack – last month
•Hypertension
- On 3 Antihypertensive
(T Perindropil 8mg OD, T Amlodipine 5mg OD,
T Hydrochlorothiazide 25mg OD)

7. • Does not consume Red meat regularly
• No family hx of breast / colon/ thyroid ca
• Housewife
• Has 3 children
• Breast fed all her children, youngest is 19yrs
• Menopause for 5 years (not on HRT
treatment)

8. • BP : 143/96 mmHg
• PR : 86 p/min
• RR : 20 b/min
• Temp : 37.0°C
•Hemicolectomy with double barrel Stoma
•Tumour at the descending colon

17. DATE ISSUE WARD RECOMMENDATION OUTCOME
MANAGEMENT
18/06/12 Absence of No antiemetic Start IV IV
antiemetic in tx given on Metoclopramide Metocloprami
of vomiting admission 10mg TDS de started on
Pt. been 19/06/12
vomiting for the -vomiting
past 3 days frequency
reduced from
x3/d to x1/d
18/06/12 Inappropriate Fleet Oral Should be given
administration 45ml at 6pm, 12 hours & 2
time of fleet oral 9pm & 12MN hours before
Colonoscopy procedure (9pm
planned on on 18/06/12 &
19/06/12 at 9am 7am on 18/06/12)

18. DATE ISSUE WARD RECOMMENDATION OUTCOME
MANAGEMENT
19/06/12 Hydrochlorthiazide T. Amlodipine •Withold HCTZ till T. HCTZ was
induced hypokalemia 5mg, T. hypokalemia is withheld on the
Pt is hypertensive & Perindropril resolved 20/06/12
Potassium level is 8mg, T. Hctz •Monitor the K+ level
below range, 25mg OD
improper K+
monitoring
24/06/12 Inappropriate T. Cefuroxime IV Cefoperazone 1g
administration of T. 500mg BD + T BD + IV
Cefuroxime and T. Metronidazole Metronidazole
metronidazole in 400 mg TDS 500mg TDS on
chemoprophylaxis of started on 20/06/12 post-op
surgery 24/06/12
surgery was on
20/06/12, not started
with any abx

19. DATE ISSUE RECOMMENDATION OUTCOME
27/06/12 Counseling on Fleet Oral as 1. Avoid fibre diet 3 days before the Pt Understood
a discharge medication for procedure: avoid vegetables, fruits with
skins/seeds, nuts, whole grain cereal/breads. well
colonoscopy 2. Only consume soft diets a day before
the procedure until 6pm (eg. Soup, porridge)
Colonoscope is on 27/7/12 After 6pm, drink only clear liquids and juice.
For food, can take plain jelly without added
fruits or toppings.

20. Antihypertensive
• Pt had sudden SOB on 24/06/12 night & BP
shoot up to 150/89mmhg
• pt was on T.perindropril 8mg OD and
T.Amlodipine 5mg OD
• The T.amlodipine 5mg OD was converted to
T.Felodipinie 5mg and patient tolerated &
responded well.
• The BP was under control.
1)Manzo BA, Matalka MS, Ravnan SL, Evaluation of a therapeutic conversion from amlodipine to felodipine, 2003 Nov;23(11):1508-12.
http://www.ncbi.nlm.nih.gov/pubmed/14620396
2) Parra D, Beckev NP, Korman L , Retrospective evaluation of the conversion of amlodipine to alternative calcium channel blockers,
2000 Sep;20(9):1072-8, http://www.ncbi.nlm.nih.gov/pubmed/10999500

21. 1. Patient discharged on D of admission, with medication :-
• T Celecoxib 200mg PRN x 10/7
• C. Omeprazole 40mg OD x 2/52
• T. Felodipine 5mg BD x 2/12
• T. Perindropril 8mg OD x 2/12
• T. Metronidazole 400mg TDS x 1/7
• T. Prednisolone 40mg OM x 2/7 CT TAP on 9/8/12 at
Serdang Hosp
• T. Prednisolone 40mg ON x 1/7
• T. Cefuroxime 500mg BD x 1/7
• Sol. Phospho Soda Oral 45ml BD ( for colonoscopy on 27/7/12)

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