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.

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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.

Thanks Dr D Murli.
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Intestinal obstruction May be required surgical exploration

Thank you Dr. Partha Sarathi Sahana Sir Ji
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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

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