How to Grade? - Grey Zone Cases

Over the past five years, we were confronted with a couple of clinical cases, in which the grading of complications turned out to be difficult. Such cases were prospectively collected at our center.



Example of "grey zone cases"




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Scenario 2
A right hemihepatectomy was performed elsewhere due to a metastatic disease in a 75-year-old woman. Then, the patient developed signs of sepsis on postoperative day 3. The same team performed a relaparotomy, revealing a perforation of the small intestine, which required a partial colonic resection. The patient showed persisting signs of sepsis and hemodynamic instability, and was later referred to our center. Due to the deterioration of the patient’s condition, including respiratory and renal failures, the patient was reintubated. A third laparotomy disclosed an insufficiency
of the intestinal anastomosis, which was corrected with a new anastomosis. An intraperitoneal VAC system had to be applied because of the retraction of the abdominal wall. Subsequently, several laparotomies were necessary over the next few weeks because of recurrent leakages in the small intestine. Finally, the patient expired in our ICU after 25 days.


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