Concluded Case

ACUTE ABDOMEN

A 46 year old male pt attended the Emergency with chief complaint of abdominal distension and diffuse abdominal pain since 3 days. Pt had no history of nausea,vomitings,constipation. No history of trauma. He is a known smoker and alcoholic since 15 years.He did not have a surgical history and any underlying diseases. On Evaluation :He has vital signs with a PR-150/min ,RR-22/min, Temp -103F and a Bp-140/80mm of Hg. On Physical Examination:Local rise of temperature with Diffuse abdominal Tenderness, Guarding and Rebound tenderness is noted. Chief Complaints abdominal distension and diffuse abdominal pain Vitals PR-150/min ,RR-22/min, Temp -103F and a Bp-140/80mm of Hg Physical Examination On Physical Examination:Local rise of temperature with Diffuse abdominal Tenderness, Guarding and Rebound tenderness is noted. Management WHAT IS THE NEXT LINE OF MANAGEMENT?

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Concluded answer

A case of Sma thrombosis with gangrene from 10cm distal to DJ felxure to distal half of ascending colon . Resection and jejuno transverse end to side anastomosis has been performed. Pt survived with a fecal fistula which was managed conservatively and now on follow up . Pt also complains diarrhea -SBS a sequel of such large resection. Currently on follow up and is malnourished post op 8 months .

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He is having peritonitis.A CECT will help in planning surgery.. Meanwhile start hydrating the patient and asses the condition of liver lung and cardiac co morbidities to predict outcome.. Start on broadspectrum antibiotics after securing good venous access

X ray erect abdomen has insignificant findings,Cect abdomen - revealed dilated bowel loops with lack of mucosal enhancement, and filling defect in SMA likely Sma thrombosis with bowel gangrene !
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As per history there is rise of local temp Rebound tenderness Muscle gaurd + Distension of abdomen Diffuse abd pain with h/o fever and tachycardia All findings are suggestive of acute appendicitis with likely bursting Needs surgical intervention in emergency

Yes sir one of the Dd may be peritonitis due to appendicular perforation.
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A case of Sma thrombosis with gangrene from 10cm distal to DJ felxure to distal half of ascending colon . Resection and jejuno transverse end to side anastomosis has been performed. Pt survived with a fecal fistula which was managed conservatively and now on follow up . Pt also complains diarrhea -SBS a sequel of such large resection. Currently on follow up and is malnourished post op 8 months .

@@may be alcoholic liver disease ,do usg whole abdomen admit in casualty under NPO and start symptomatic treatment and do all routine investigations. .

Occasional alcoholic , and moreover per abdominal findings lead to suspicion of an acute abdominal emergency . Hence management differs .
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Diseases Related to Discussion

Constipation
Acute Appendicitis
Appendicitis
Peritonitis
Xlcm