Thursday, May 31, 2012

CASE: Strange case of abdominal poly trauma

35 yrs female had high spike of fever, sever pain, agony, distension, shortness of breath, and constipation for 6 days..with swelling (irreducible) in rt flank, tachycardia, and low urine out put..

( Patient had h/o with fall from 4 feet height and sudden onset pain and appearance of swelling in rt flank..
USG: S/O liver laceration/hematoma with mild free fluid, and intermascular colonic hernia
CT SCAN ON day 4:s/o liver tare,hematoma, moderate free fluid perihepatic,para colics, and intermascular hernia of colon
was kept conservatively, with application of abdominal binder..and was discharged on day 6..)

after resuscitation USG/CT was done
s/o gross free fluid and on aspiration it was infected bile.

plan: ERC And stenting followed by surgery (lavage and drainage)

ERC: S/o total loss of biliary tree structure with p/o major CHD/CBD transection, stenting was done

SURGERY: Findings: 1. Trapped interperital hernia in rt hypochondrium with transverse colon
2. 1.5 liter biliary peritonitis
3. liver leceration,hematoma in seg 5,6,

procedure : 1. lavage, drainage, reduction of hernia, intarnal mascular interupted absorbable sutures (no mesh) was done.
2. cholecystectomy, hilar exploration identification of ducts, CBD, "T" TUBE insertion from Right duct to CBD-Duodenum, left system 10 fr drainage tube placement, sub and supara hepatic,pelvic, paracolic drains.
3.  Feeding jejunostomy

patient recovered and was discharged with SUBHEPATIC DRAIN, BLOCKED T TUBE, open left duct stent, with refeeding of bile via FJ. on POD 16.

Planned for DEFINITIVE HJ After 2 months.