Case Study
Health advice: Colorectal surgery
A member with a history of monoclonal gammopathy of undetermined significance (MGUS), complicated by hypogammaglobulinaemia, thrombocytopenia and a compromised immune system requiring intravenous immunoglobulin (IVIG), sought a second opinion through their life insurer’s member benefits program regarding a recommended laparoscopic right hemicolectomy.
The member had a history of daily bowel distension and constipation. A PET-CT scan identified a malpositioned caecum with flattening of the proximal ascending colon, suggestive of intermittent partial bowel obstruction. Following review by a colorectal surgeon, a laparoscopic right hemicolectomy was recommended. However, the member was concerned about the balance of surgical risks and benefits given their underlying immune status.
The case was allocated to an independent colorectal surgeon, who reviewed the member’s medical records, including the recent PET-CT scan and haematologist’s report, before conducting a telephone consultation.
The specialist advised that surgery was not currently recommended, as the member’s compromised immune system significantly increased the risks associated with major surgery, particularly the risk of infection. They recommended obtaining formal clearance from the treating haematologist, together with an assessment by a perioperative physician to evaluate and, where possible, reduce the surgical risks.
Outcome
As the member’s symptoms were well controlled, the specialist advised that the bowel malrotation was not life-threatening and surgery was not mandatory at this stage. They also recommended further investigation of gastrointestinal transit time, including assessment of gastric, small bowel and colonic transit. If the symptoms were found to be related to slow-transit constipation, a partial colectomy might not provide significant benefit if slow transit was affecting other parts of the bowel.
The member was also advised that, should they experience symptoms suggestive of an acute bowel obstruction, they should present to hospital promptly for assessment.