Concluded Case

Emergency presentation of a proximal colonic mass(case summary)

This middle aged patient presented with dehydration+++, huge abdominal distention,pain in rt lower quadrent..(no fever),respiratory distress and features of hypovolaemic shock..history of passing blackish stool for several episodes.plain abdominal radiograph showed hugly gas distended bowel loop.blood biochemistry revealed electrolyte imbalance(Na+,K+ reduced),CT not available at that time.. Provisional dx was suspected malignancy in proximal colon.. .after iv resuscitation urgent laparotomy was performed...findings..no ascitis,or hepatic/peritoneal seedlings.. A stricture just distal to hep-flex....right colon was enormously dilated,,impanding caecal rupture!!. After Mobilisation of rt colon, and splenic flexure extended rt hemicolectomy was done with 5 cm clear margin distally with exteriorisation of both bowel ends done...patient recieved two units of WB preoperatively and ICU shifting post-op.

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Rt job done

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As it is case of intestinal obstrution to mass in the hepatic flexure leading to di lation of the gut proximal to obstruction leading to vomiting resulting electrolytes imbalance and dehydration. Right decision for going rt sided hemicolectomy after resuscitation Wel done..

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Rare presentation Stricture distal to hepatic flex Likely malignant Well done in your limitations in a emergency situation as pt was in hypovolumic shock

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Rt job done

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