Monday, June 11, 2012

CASE: Unusual case of bowel ischemia^-www.drkeyurbhatt.in*

42 YRS male, non diabetic, non smoker, non Hypertensive
presented  with sepsis, shock, ARF (urea 91, Creat 2.1), P: 140, BP: 90/60 On inotrops..drowsy,

 ( p/h/o: pain in abdomen for 2 days and USG at that time s/o free fluid in abdomen (moderate) with non visulization of appendix / ? perforated appendix...and hence operated for open appendectomy, post op patient did well for 2-3 days , started having fever, distension, pain, low out put on POD 3....AND was referred on POD 7 night )

Abdominal drain was draining dirty , purulant fluid, after adequate rehydration, USG Done s/o dilated aperestaltic bowel loops with multiple pockets of collection through out the abdomen (on aspiration which drained feculant material )

ABG: WAS s/o over compensated alkaline pH.

Was taken up for surgery suspecting stump blow out / cecal perforation with peritonitis

OF SURPRISE:  It was TOTAL MESENTERIC ISCHEMIA WITH GANGRENE OF SMA region..with 1.5 liter of toxic fluid in abdomen...unfortunately ...we could not do much for the patient....


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