Concluded Case

PERFORATION ???? DILATED BOWEL LOOPS WITH INTER LOOPS COLLECTION

A 26 years old male patient, complaining č severe abdominal pain, he is unable to sleep on the bed . USG show " dilated bowel loops with significant inter bowel loops collection. At the time of admission PPI Metrogly Camylofin Pipzo Other haematological investigations are on process O/E is normal finding Suggest for surgery. Laparotomy

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Acute Intestinal Obstruction, Plan for Plain Radiography of KUB W/A & when there is an interruption in the forward flow of intestinal contents. This interruption can occur at any point along the length of the gastrointestinal tract, and clinical symptoms often vary based on the level of obstruction. Intestinal obstruction is most commonly caused by intra-abdominal adhesions, malignancy, or intestinal herniation. The clinical presentation generally includes nausea and emesis, colicky abdominal pain, and a failure to pass flatus or bowel movements. The classic physical examination findings of abdominal distension, tympany to percussion, and high-pitched bowel sounds suggest the diagnosis. Radiologic imaging can confirm the diagnosis, and can also serve as useful adjunctive investigations when the diagnosis is less certain. Although radiography is often the initial study, non-contrast computed tomography is recommended if the index of suspicion is high or if suspicion persists despite negative radiography. Management of uncomplicated obstructions includes fluid resuscitation with correction of metabolic derangements, intestinal decompression, and bowel rest. Evidence of vascular compromise or perforation, or failure to resolve with adequate bowel decompression is an indication for surgical intervention. Radiography is an effective initial examination in Pt. with suspected intestinal obstruction.Clinically stable patients can be treated conservatively with bowel rest, intubation and decompression, and intravenous fluid resuscitation.Surgery is warranted in patients with intestinal obstruction that does not resolve within 48 hours after conservative therapy is initiated.
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Emergency surgery advise
Acute Intestinal Obstruction, Plan for Plain Radiography of KUB W/A & when there is an interruption in the forward flow of intestinal contents. This interruption can occur at any point along the length of the gastrointestinal tract, and clinical symptoms often vary based on the level of obstruction. Intestinal obstruction is most commonly caused by intra-abdominal adhesions, malignancy, or intestinal herniation. The clinical presentation generally includes nausea and emesis, colicky abdominal pain, and a failure to pass flatus or bowel movements. The classic physical examination findings of abdominal distension, tympany to percussion, and high-pitched bowel sounds suggest the diagnosis. Radiologic imaging can confirm the diagnosis, and can also serve as useful adjunctive investigations when the diagnosis is less certain. Although radiography is often the initial study, non-contrast computed tomography is recommended if the index of suspicion is high or if suspicion persists despite negative radiography. Management of uncomplicated obstructions includes fluid resuscitation with correction of metabolic derangements, intestinal decompression, and bowel rest. Evidence of vascular compromise or perforation, or failure to resolve with adequate bowel decompression is an indication for surgical intervention. Radiography is an effective initial examination in Pt. with suspected intestinal obstruction.Clinically stable patients can be treated conservatively with bowel rest, intubation and decompression, and intravenous fluid resuscitation.Surgery is warranted in patients with intestinal obstruction that does not resolve within 48 hours after conservative therapy is initiated.
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USG finding alarming finding is the inter bowel loop collection . The causes may be due to hollow viscous perforation followed by peritonitis giving rise to inter bowel loop collection or may be due any septic process intra abdominal leading to peritonitis and secondary inter bowel loop collection Now to establish the perforation of hollow viscous Str x-ray in standing position to see any gas under the diaphragm CT abdomen to see sub diaphragmatic gas and also if any Infective intra abdominal pathology Management NPM IV drip to continue for nutrition and elctrolytes Inj Ceftriaxone 1 gm + Salbactum 500 IV twice daily Inj Metrogyl 100 tds IV Inj multi bit infusion daily Inj PPl IV daily Laparotomy as per the xray and CT finding.
Thanks Dr Maqusud Ansari.
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In this case it is important to confirm it rule out perforation of bowel X ray abdomen standing and CT scan of Abdomen with Pelvis will help in confirming or ruling out perforation
u should start Suvarna Soot Shekhar rasa instead of plain soor shekhar rasa. If u think there is Ama dosha present, give him Vamana otherwise plan for sasneha virechana.
Perforation or ascites Xray ap abdomen Ct abdomen auscultation Laprotomy repair nbm
SUGGESTIVE OF ACUTE INTESTINAL OBSTRUCTION NEEDS. SURGICAL. INTERVENTION
Yes laproscopic laprotomy is advisable
Thanx dr Deepak Raj
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Yes need Emergency laparotomy
Need emegency laparatomy
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