I am really lucky to find such this service that you offer for people to get answers of their medical inquires and I hope to get reply to my message that may help my father who was with abdominal distention for 4 days before he admitted to general hospital as an emergency case then he admitted to ICU because as doctors say his oxygen saturation is decreased then he lost his consciousness and they do investigations include colonoscopy to find there is tumor obstructed colon which make it urgently to do laparotomy and remove the tumor and found perforation in the intestine which filled the abdomen with pus and leaded to generalize peritonitis. After removing of tumor and doing lavage and drains to abdomen they admitted him to I.C.U back again and put him on ventilator and sedation and do culture to find the sensitive antibiotics then started treatment and drains were coming out from his abdomen with very little urine output and losing of consciousness and we got the result for the tumor as they said it's adencarcinoma with complete circumferential affected means the cancer reached peritoneum but the two ends are normal as doctor in histopathology lab said then nephrologists told us he needs hemodialysis because createnine is high and stated dialysis for more than on month and he was intubated for long time but the drains of abdomen is removed and the surgeon told us his abdomen now is improved but they say he needs to do tracheostomy and they did it and connected to ventilator
Then createnine is decreased to 260 and less and urine output is increased and they stop dialysis for 2 weeks after that nephrologists said he needs dialysis again because urea is high and did dialysis yesterday but still breathing on ventilator because as they said he does not have sufficient gas exchange and in coma but they told me improvement of liver function and kidney function do not improve his consciousness because as they said we expect another reason but X-ray and CT scan did not show any embolism because they said my father had deep vein thrombosis in thigh and with dialysis and heparin it will move to another place but CT scan did now show neither in chest nor in brain.
I am really sorry I could not write the actual case of my father briefly because I know the case is critical and wanted you to know all the problems before I asked you about the possible reasons of unconsciousness in such this case

Dear Amal

Thank you for your detailed explanation

What about age? you didn't mention it.

We can say that the embolism had been excluded. (but did they do renal ultrasound? what is about his Blood Pressure?)

However he may have an acute renal failure due to indirect affect of the malignancy. or may have an obstruction (because of the tumour or metastases.)

The decreased createnine level (to 260) is still high (If you use the unit µmol/L) the normal value is 70-150 µmol/L

He may have a chronic renal failure which had been exacerbated by the previous mentioned reasons.

The coma may be uraemic.

I hope to hear from some collegous his/her opinion.

God save you and your father

Thank you Dr.Shankool for your reply
His age is 72 but actually I do not know about his blood pressure but I think it was high when he admitted to ICU before 2 months but when they did the operation he lost too much of blood. did this lose of blood affect the brain forever? and the size of his kidney as doctors said normal but as the said too kidneys looks like pottatoes means maybe something inside have been affected but high pressure or by indreat effect of tumor as you said or by other reasons. but what makes urea increases? and what about his breathing he can not breath without ventilator? does this related to coma? and what are the other possible reasons of coma if his brain photography did not show any emoblism or metastasis.
Thank you for all people who will participate in this disscution to find a way to help my father and thank you again Dr.Shankool

Definitely your father need MRI for the brainDefinitely your father need MRI for the brain
because it could be metastasis
by the way are a doctor? I'm asking because u used medical terms

Thank No body for your reply but does MIR conforms if there is metastasis
I'm not a doctor. I'm only English teacher but I talk with doctors who provide care for my father and I got complete medical report and I hope this will give you clear picture of the case to have consultation or your adivice to help my father.
Medical Report
Age/sex: 72 yars/ Male
Diagnosis: Fecal peritonitis on top of colonic perforation, cancer colon, post operative renal failure
Medical history
Patient bedreidden since 5 years due to severe Osteoarthritis under treatment

Five days before admission patient complaint vomiting, constipation, progressive abdominal distension with no abdominal pain

On examination patient was drowsy, dyspneic, afebrile, Bp 140/90, and PO2 80% on room air. Abdomen was highly distended, hyperresonant, intestinal sounds are audible otherwise soft, lax with no palpable masses and hernial orifices were free. PR: empty rectum

Laboratory results show, no leucocytosis, raised hematocrit levels, liver and renal parameters within normal levels. X-ray abdomen shows hugely distended colon. Enema with gastrograffin shows no obstructive lesion and no intra peritoneal spillage of the dye

Acute colonic psodo obstruction (ogilvie's syndrome) was retained. As primarily diagnosis in critically ill patient.

Patient admitted to ICU and intubated, mechanically ventilated

Urgent colonic decompression was decided and done with collaboration with gastroenterologist revealing colonic tumor of the left side, liver and renal parameters start to be disturbed

The patient condition was reviewed by a multidisciplinary team after gastroenterologist findings as the patient carry a high risk of surgical and anesthetic problems. The patient family was informed as about actual condition and that surgical procedure was the only hope

Patient operated 2 months ago , exploartion revealed Caecal perforation, peritonitis and Hartman procedure done

On the post operative period patient was stll critically ill, mechanical ventilation maintained, as the O2 saturation drops. Hemodynamically patient unstable, and vasopressor drugs were instituted

Renal parameters were disturbed (urea, creatinine, K ) and progressively increase and patient started to be hemodialyzed 1 month postoperativelly

At the operative site, the colostomy was functioning and evidence of wound infection present in the 7th day post operative and regularly dressed and progressively ameliorating

The post operative anemia, disturbed, coagulation parameters were effectivelly controlled with transfusion

As the patient was unconscious, mechanically ventilated for a long period decision to do tracheostomy was done 1 month post operative

Actually patient is unconscious, mechincally ventilated and on regular hemodialysis and laboratory results (blood picture, liver functions, renal functions) controlled

This is a complete medical report for the case
Please all medical students and doctors who can make these points clear for me and give me adivice and what predicts of such this case to participate even with one word at least which may let others give more in detail
Thank you Dr.Shankool & No Body for your replys and I I'm looking forward to read more from both of you

DEAR

AMAL
Your father had undergone a massive operation to manage a serious emergency which are fecal peritonitis after colon perforation due to colon cancer
When any body has peritonitis it will cause a major disturbances in his body fluids and electrolytes and when it is fecal there will be a greater risk because of sepsis with highly morbid organisms esp anaerobics
And that may lead to multisystemic complication
In addition to that this operation _which was of course life-saving_carry an additional risk because of blood lose and accompanying coagulation problems

So all of that led to acute renal failure which contribute with the electrolytes disturbances in causing the coma

In addition to that your father carry a high risk of surgical and anesthetic problems but the operation was the only way to save him

So I thing your father had also respiratory complication next to the anesthesia and that was an additional factor in prolonging his coma

At the end I can assure you that all the decisions and procedures thas was taken by your father therapist was life saving and very professional

GOD BLESS YOU AND YOUR FATHER

Thank you sooo much d.zf for your logical and professional reply in which you analyzed the points and gave me clear understanding for the complications and progress but please I want to know what can they do more for him and what are the predictions of such this case
What is the early mortality rate in such this case and can he be cured and recover from all these problems

Thank you again and I'm looking forward to read more from you and others

dear amal
i need further information about ur father condition
1- what are creatinine and urea values?
2- what are his oxygen saturation and pattern of respiration

PLEASE DELETE THIS TOPIC
MY FATHER DEAD

dear amal
i am really sorry for your lost
God bless him and give you the strength and patience