A difficult abdominal case

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He has total obstruction - also called obstipation. While this is not
primarily trauma, my advise would be:

Fluid sot correct electrolytes and suck on the NGT. Just exclude
pancreatitis. If pancreatitis excluded he needs surgery - obstipation is
an absolute indication for exploration.

It is likely to be either a mass lesion in the large bowel or adhesive
obstruction if he had previous surgery. If he is from a place with a
high TB incidence - think also of abdominal TB.

Let us know what you find!

Tim
Dr Timothy C Hardcastle
M.B., Ch.B. (Stell); M. Med (Chir) (Stell); FCS (SA)
Principal Surgeon-Lecturer / Sub-specialist: Trauma and Critical Care
Deputy director: Trauma Unit and Trauma ICU
Inkosi Albert Luthuli Central Hospital / UKZN
800 Bellair Road
Mayville, Durban
 
Postal: PostNet Suite 27
Private Bag X05
Malvern, 4055
KwaZulu Natal
 
timothyhar at ialch.co.za 
 

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of rm khattar
Sent: 08 July 2008 13:52
To: trauma-list at trauma.org
Subject: A difficult abdominal case

A 40 year man is admitted with 5days history of abdominal pain
,inability to pass flatus and motion,distention of abdomen and vomiting.
No significant past history. On examination he is mildly dehydrated
,looks sick,and has tachycardia and looks in agony and has tender hugely
distended abdomen with absent bowel sounds. There is redness on
abdominal wall in both flanks. He has a indwelling urinary catheter
draining concentrated urine, Ryle's tube in situ with whitish
aspirate.His TLC,Urea ,Creatinine are high and he has mild  non
obstructive jaundice,biochemically.He is carrying a CECT abdomen  from
the hospital where he was previously admitted which shows
intraperitoneal fluid and diagnosis of SBO.
What are the diagnostic possibilities?
What is the further work up?
What treatment should be offered?
R.M.Khattar
Delhi,India
Consultant Surgeon.  


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