Case of the day


70 years old man admitted with complaining of vomiting 5 times of 1 day duration green in colour. Hard stool and decreased frequency of passing bowel(partial constipation) of 5 days duration. No abdominal pain.Decreased vision since 2 days Abdominal x ray showed dilated bowel loops with multiple air fluid level.. Which CT scan with contrast of abdomen plus brain CT scan was ordered. Chief Complaints Vomitting, Decreased vision,Unable to pass stool History Had episode of stroke 4 days ago. HTN/DM. Vitals BP 120/60mmhg spo2 95 on air room. Physical Examination Conscious, oriented, GCS 15/15.. On abdominal examination no tenderness. No distension Investigations WBC - 15000,Hb -10,PC - 2lakhs,Urea - 20,Creat - 0.88,K-2.2,Na -128,RBS -128, Coagulation profile - Normal Diagnosis DIAGNOSIS AND SUGGEST MANAGEMENT PLAN? Management Treatment given in the emergency room NG tube decompression, IV Fluid ,Antibiotics,AEDs,DAPTs



Main Diagnosis is Acute intestinal obstruction with multiple air fluid levels. MRI and NCCT shows lacunar infarcts and chronic small vessel arteriosclerotic changes .Doesn't look like acute cerebral changes. Treatment- NPO RT suction IV FLUIDS PARENTERAL ANTIBIOTICS If obstruction is not relieved in 24 - 48 hours an Exploratory laparotomy is indicated A CECT abdomen can help in pin - pointing site of obstruction

Valuable opinion

Ischimic areas seen are ageing infarcts otherwise no life threatening lesions seen Kub do shows multiple fluid levels suggestive of SAIO Leucocytosis with hyponatremia are the reason for clinical presentation Yes treat as CVA with septicimia Rx iv inj NS Inj RL Inj dexamethasone Inj Ceftriaxozone I nj lasix Inj ondestron Inj pantaprazole Rest supportive treatment Oralyy ecosprin Consider inj clexan as per clinical status

Thanx dr Mansukh Shah

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Lacunar infarct Rt occipital region Hyponatrimia Hypokaelemia Leucocytosis Opinion of neurologist Physician

Anticoagulants, get cect abdomen, Antibiotics, get abg, hydration, if any signs of peritonitis get laprotomy

Sub Acute intestinal obstruction

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