The medical team was asked to review a postoperative surgical patient. A 62-year-old lady had been admitted 10 days previously to have a right hemicolectomy performed for a caecal carcinoma. This was discovered on colonoscopy, which was performed to investigate iron-deficiency anemia and change in bowel habit. She is otherwise fit with no significant medical history. She is a retired teacher. She neither smokes nor drinks alcohol and is on no medication.
Her preoperative serum creatinine was 76 μmol/L. The initial surgery was uneventful, and she was given cefuroxime and metronidazole as routine antibiotic prophylaxis. The patient developed a prolonged ileus associated with abdominal pain. On postoperative day 5, the patient started to spike fevers up to 38.5°C and was commenced on intravenous gentamicin 80mg, 8 hourly in addition to the other antibiotics. Over the next 5 days, she…
