18 years old female presented with pain abdomen with distension and fever with weight loss of 15 days duration Clinically intestinal obstruction and ascites Imaging done
Fluid Ada normal normocellular high protein low saag Cytology negative for malignancy Target sign of small bowel. Vasculitis workup sent ANA positive Lymph nodes noted in abdomen Eus fna done
Presence of intestinal obstruction along with ascites in young patient with constituional symptoms suggests infective etiology rather than inflammatory disease.. Most likely Tuberculosis ,crohns disease ,eosinophilic enteritis or vasculitis. Comsider EUS FNA of the lymh nodes .
Small bowel obstruction with high protein, lymphocyte predominant ascites and pleural effusion with h/o fever and weight loss: 1st differential should be Abdominal TB. Need to go for Ascitic fluid ADA with Pleural fluid R/M and ADA. Mostly will require exploratory laparotomy with resection of any stricture and histopathology of resection specimen will give you the diagnosis and accordingly start therapy
NBM Ryle tube Catherization Monitor vital data BP, pulse, RR, input o output chart IVF +Inj multivitamins Meropenem / tazobactun +papracillin Inj metro Inj pan 40mg Inj emset Inj tramadol Exp. laparotomy Release obstruction Intra operative manage bowel resection / not. anastomosis / not Tissue, ascites Fluid, pleural Fluid Send for AFB, R /M and C /S by bactaet method ATT start as per report
Fluid Ada normal normocellular high protein low saag Cytology negative for malignancy Target sign of small bowel. Vasculitis workup sent ANA positive Lymph nodes noted in abdomen Eus fna done
Ascitic fluid cytology and protein content proved no malignancy, on the other side presence of pleural effusion makes the suspiscion of tuberculous origin so we can start conservative treatment and other investigation for tubeculous origin.
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