A 73 yr old Male pt Known case of ulcerative colitis. on mesalamine and azathioprine presented with sudden onset of altered sensorium, passing of dark fowl smelling stools abdominal distension since oneday Pat also had inflammatory arthritis.. X-ray abdomen erect ap view showed following picture. diagnosis and treatment please.



Gas under right dome of diaphragm indicative of perforation peritonitis. Causes could be peptic ulcer perforation due to NSAIDS for inflammatory arthritis. Another cause is a complication of ulcerative colitis where perforation is known to exist Urgent resuscitation with RT suction, IV fluids and R.L , parenteral antibiotics and prepare for exploratory laparotomy

Long standing IBD (Ulcerative Colitis) with sudden onset of altered sensorium and abdominal distension can be due to Megacolon ( a rare condition due to long standing IBD specially with ulcerative colitis)...Xray is showwing dilated bowel loops in favor of it Acute Exacerbation of IBD only....

Pneumoperitoneum and megacolon. Bcoz of immune modulation signs of toxic colon or peritonitis may be masked. Em Laparotomy and proceed... depending on fitness and ASA grade. Options... TPC and end ileostomy Proximal diversing ileostomy or colostomy after thorough peritoneal lavage and drains. If no perforation or severe sepsis or poor GC for Sx...trial of infliximab

Acute severe colitis with toxic megacolon and suspected perf...

Gas under the right dome of diaphragm Suggestive of hollow viscous perforation Airway protection Insert RT Insert a central line and target CVP 8-10 Inj.Piperacillin+Tazobactum 4.5gms IV/8th hrly IV Metro 100ml IV/8th hrly Analgesics Supportive management Suggest: CT abdomen Will need Exp lap

Toxic megacolon due to ulcerative colitis. There appears to be gas under RT dome of diaphragm indicating perforation

X-RAY shows gas under rt dome of diaphragm suggestive of intestinal perforation, require immediate surgical intervention with repair of perforation and management on line of acute abdomen NBM, Rules tube suction continuous,IV fluids, Antibiotics cefaperazone-sulbactum,IV metrogyl,IV Mesalamine IV Pantocid etc.will relieve the patient.Do regular serum electrolytes and maintain.Give blood transfusion if needed.

Perforative peritonitis.

Toxic Megacolon with s/o perforation. Immediate exploration following resuscitation

Xray suggestive of bowel perforation altered sensorium may be due to sepsis or dyselectrolytemia

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