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 3:
A 57-year-old patient underwent an elective anterior sigma resection for a cancer. The patient developed excruciating abdominal pain, a high-grade fever, and leukocytosis 5 days after surgery. The patient was taken back to the OR, where an anastomotic breakdown was documented. A Hartmann’s procedure was performed. Then, the patient was admitted to the ICU, and developed an ARDS and renal failure requiring dialysis over the next few days. A number of other problems occurred including a wound infection treated at bedside and deep vein thrombosis, requiring anticoagulation. The patient died 17 days later.


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