72-year-old man for colonoscopy via fast-track pathway following a positive FOB
- +ive FOB in community. No new bowel symptoms noted
- Initially planned for Cessnock hospital and was deemed unsuitable due to co-morbidities
- Presented to Belmont on day of procedure and was cancelled due to co-morbidities. Had already undergone bowel preparation.
- Notes form Belmont state “unsuitable for Belmont and possibly anywhere.’
- Significant chronic health conditions.
- Dementia. MMSE 4/15. Wife is man carer. Requires assistance with all ADLs
- OSA – requires CPAP but can’t tolerate
- IHD with 3 cardiac stents in situ
- Episodes of VT – 2 ablations in past
- Aortic regurgitation and mild pulmonary hypertension
- AF, anticoagulated with DOAC
- Significant orthopnoea, sleeps in chair
- NIDDM with excellent control. On SGLT2 only
- Noted to have raised CRP and ESR on perioperative bloods. WCC normal.
- Excellent program for early detection of bowel cancer in patients
- Patients are fast-tracked to colonoscopy without seeing proceduralist in order to minimise delay
- May not have been beneficial in this Complex patient. Surgical/gastroenterologist review may have identified the patient complexities/uncertain suitability for colonoscopy
- Concerns expressed regarding cancellation on day of procedure after bowel prep. Not evident if plan in place to optimise/review patient prior to booking the colonoscopy at JHH
Should colonoscopy go ahead?
- Patient likely not suitable for surgical procedure if cancer discovered on colonoscopy
- May be able to have diagnostic or symptom-control procedure if required
- Consider CT Colonoscopy? may be difficult with orthopnoea
Raised ESR and CRP
- Not on any causative medications
- Unlikely to have a new diagnosis of inflammatory bowel disease at 72
- Consider discussion with gastroenterologist
- Discuss with surgeon regarding suitability of procedure
- Gastroenterologist referral
- If colonoscopy proceeds, may require admission to hospital for bowel preparation.
- Pathway for referral of these complex patients between hospitals/perioperative clinics. Consider development of a referral pathway/guideline