CASE: Abdominal tuberculosis with blown out appendicular stump^-www.drkeyurbhatt.in*

Sunday, November 14, 2010

CASE: Abdominal tuberculosis with blown out appendicular stump^-www.drkeyurbhatt.in*

Past history: 60 Yrs male operated once for minimal peritonitis in third week of oct (out side surat).---developed burst abdomen 1 week later---operated for closure of burst... ------went well started on orals ....passing stool....

Once again developed features of peritonitis and respiratory distress... Rt sided ICD was kept and drained 1.5 liters of fluid... CECT abdomen showed gross free gas
and TLC was rising ...

It was decided to operate up on and found to have mesenteric thickning and multiple peritoneal nodules.... (probably missed in previous surgery) + free gas...pus pockets and bilio enteric leakage....gross adhesions in abdomen as it was third surgery in 18 days...for a 100 kg fatty man.

I found appendicular stump blown out----- transfixed and proxymal diverting loop ileostomy done along with mesenteric noduler biopsy....

pt on venti for 5 days ---- now on oral diet in room...walking.. talking.. Ileostomy functioning healthy...AKT started. patient ready for home care in few days...

Histology: suggestive Caseating Granuloma s/o TB