Pt was rushed into the E/R on account of generalized abdominal pain which he graded 10/10. He had 1 episode of vomiting yesterday, constipation for 4days, fever, postprandial pain and anorexic. On examination, middle aged male who acute on chronically ill, not in any obvious respiratory distress, apallor, anicteric, hydration fair, no clubbing, no bilateral pedal oedema, no palpable nodes. There was Left inguino-scrotal hernia repair surgical scar which was done last month, tenderness in the epigastrium, left hypochondriac, left lumbar, left iliac fossa and umbilical region. Bowel sounds present but diminished. Your comment on abdominal X-ray (erect & supine) and further evaluations.
Acute intestinal obstruction. Causes could be 1.Chronic constipation with impacted faecoliths - can be treated conservatively after a proctoclyss enema 2..Adhesion obstruction 3.Volvulus sigmoid colon A CECT abdomen will be helpful
Vomiting Pain abdomen Obstipation Very significant hx for acute bowel obstruction Hx of hernial operation Now you have done a good job by advising for x-ray abdomen erect. From surgical point of view, Examination of PA and DRE will augment your diagnosis Look for tense distended tender abdomen with rigidity and guarding RT aspiration is the first line of treatment NPO Put him on injectables antibiotics PPI analgesics( tramadol) IVF Till then order RBS CBC KFT LFT coagulation profile Blood grouping And repeat x-ray If obstipation continues then laporatomy My provisional diagnosis is acute bowel obstruction due to adhesions from previous operation scar.
Intestinal obstruction Rule out any eventuality. Needs further investigations and evaluation to conclude diagnosis and treatment.
Intestinal obstruction.
It's a case of intestinal obstruction.needs surgical exploration.
Looks perforation gas under diaphragm with fluid level peristalsis present opinion of surgeon welcome with CT abdomen pelvis
Intestinal obstruction. Put on conservative line of treatment. If doesn't improve do a CECT. May need exploration
Intestinal obstruction.
Acute intestinal obstruction NBM RTS IV FLUID METRONIDAZOLE IV IV ANTIBIOTICS SYMPTOMATIC Use PC ENEMA STAT
Cases that would interest you
- Login to View the image
25 year old male patient came to hospital with history of colicky abdominal pain in left lower quadrant and not able pass motions since last 4 days. patient also had 3 episodes of vomiting since today morning. what is the diagnosis and further management? ?
Dr. Sushrut Sawarkar2 Likes23 Answers - Login to View the image
A 54-year-old man, 2 years after operation for acute obstruction by a tumor of the intestine. Now the patient is presented with pain in the pelvic region. Plz, suggest the Dx and Rx for the same.
Dr. Vaibhav Goyal2 Likes19 Answers - Login to View the image
58 years old male having abdominal pain with distension, vomiting Please diagnose the case and suggest treatment
Dr. Jagannath Sahasrabudhe1 Like28 Answers - Login to View the image
70 yr diabetic female, presented with abdominal distension since 3 days. no H\o nausea,vomiting,fever, pr bleed. per abdo distended,soft, non tender, no guarding rigidity. pulse 80, bp 130/80. on pr roomy,no blood,mass or hard stools. x-ray s\o gaseous distension,no AF levels. CT plain+contrast s\o gas distended colon. probable diagnosis n further investigation n management?
Dr. P N0 Like9 Answers - Login to View the image
.A 73-year-old female patient with past surgical history of partial colectomy due to an ischaemic colitis and multiple autoimmune diseases such as dermatosclerosis, Raynaud’s syndrome and hypothyroidism, presented to the Emergency Department afebrile with lack of appetite, nausea and worsening abdominal pain with distention
Tejas Diwate0 Like9 Answers
2 Likes