Successful Surgery Saves 61-Year-Old Patient of Cancer Rectosigmoid with Perforation Peritonitis with Septic Shock

At Kailash Hospital, Dehradun, a 61-year-old patient k/c/o ulcerative colitis on self medication was brought to the emergency department with severe abdominal pain and constipation. On examination, he showed signs of abdominal distension, weakness, and physiological distress, with low blood pressure, moderate tachycardia, and signs pointing toward peritonitis with systemic infection. Further investigations revealed a diagnosis of cancer rectosigmoid with ulcerative colitis, complicated by perforation peritonitis and septic shock — a critical and life-threatening condition.

Perforation peritonitis, caused by a rupture in the gastrointestinal tract, allows intestinal contents to spill into the abdominal cavity, triggering severe infection. In this case, the situation was further complicated by underlying malignancy and ulcerative colitis, which made the tissues friable and made surgery highly challenging.

The patient was admitted under the care of Dr. Shashwat Tiwari, Consultant Surgical Oncologist, and immediately shifted to the OT. A multidisciplinary approach was initiated, beginning with an emergency exploratory laparotomy under general anesthesia. Peritoneal lavage was performed to clear infection, and a low anterior resection with colostomy (Hartmann’s procedure) was carried out. Intraoperative findings included a perforated rectosigmoid junction, stool-filled peritoneal cavity, and dense adhesions of the sigmoid colon with surrounding structures.

Post-surgery, the patient required intensive care management. He was placed on ventilator support and treated with vasopressors, intravenous fluids, and a broad spectrum of antibiotics. Blood transfusion was administered, and specialist consultations were sought from gastroenterology and pulmonology teams to optimize his post-operative recovery. Supportive therapies including anticoagulation, pain management, nutritional supplementation, and respiratory care were also provided.

Gradually, the patient’s condition improved. By the sixth post-operative day, he was successfully weaned off ventilator support as infection markers normalized. On 18th August 2025, he was shifted from ICU to the ward in stable condition, and by 23rd August, he was discharged with detailed instructions for home-based colostomy care, physiotherapy, medications, and follow-up with Dr. Tiwari. The patient has good post-operative recovery and has been started with adjuvant chemotherapy.

This case highlights the importance of timely surgical intervention and coordinated multidisciplinary care in managing complex oncological emergencies. The successful outcome was made possible by the expertise of Dr.Shashwat Tiwari and the dedicated ICU, gastroenterology, and pulmonology teams at Kailash Hospital, Dehradun. The patient’s family expressed deep gratitude to the hospital staff for their exceptional care and compassionate support during this critical period.

Kailash Hospital continues to stand as a trusted center for advanced surgical oncology and emergency critical care, offering patients hope and healing in the most challenging circumstances.

For expert oncology care, consult Dr.Shashwat Tiwari at Kailash Hospital, Dehradun.