A difficult abdominal case

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My favourite investigation is realtime colour retinography of the  
abdomen - or in English, open the abdomen and have a look. There are a  
lot of tests you could do to delay this, or if there is some really  
good reason not to open, that you have not told us.

Nick Macartney
On 8 Jul 2008, at 12:52, rm khattar wrote:

> 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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