mild abdominal distension, no tenderness free fluid +
pt roaming around..taking oral diet..passing stool...but constant discomfort
USG: S/O Loculated free fluid and matted bowels p/o Koch's
CECT: Similar findings with dilated appendix with Fecolith in appendix..p/o Koch's
ADA : 150 (normal up to 60)
so by this all means Koch's was almost certain....
but the surprising thing was TLC: 22,000...So fluid (turbid) was aspirated and sent for exm. and showed frank pus (fluid count >75,000 and protein > 3.5: s/o exudate and pus)TLC Elevated to 29,000 (still pt walking, no fever, passing stool, no vomiting) but decision of exploration was taken with consensus of GI Physician, Physician, And Me. and what we found.....1.5 liter of pus with 1 kidney tray full of pus flakes....
sometimes even clinical judgement and Radiology both can miss lead but pathological diagnosis is always confirmatory....(fluid examination, TLC)...and can save lives....
Dr. Keyur Bhatt - Best
Gastro Surgeon
Dr. Keyur Bhatt- Best GI
Surgeon
Dr. Keyur Bhatt - Best
Gastro Surgeon
Dr. Keyur Bhatt- Best GI
Surgeon - Dr Keyur Bhatt - Best Gastro Surgeon
Dr. Keyur Bhatt- Best GI
Surgeon - Dr Keyur Bhatt - Best Gastro Surgeon
Dr Keyur
Bhatt- Best GI Surgeon
