case presentation n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Case Presentation PowerPoint Presentation
Download Presentation
Case Presentation

Loading in 2 Seconds...

play fullscreen
1 / 41

Case Presentation - PowerPoint PPT Presentation


  • 73 Views
  • Uploaded on

Case Presentation. Dr.Mohammad Amin K Mirza Saudi Board of Surgery Holy Makkah, KSA 2008. History & Clinical Data. 34 y.o Saudi, female Pt, Married Came to ER c\o: Lt sided abdominal pain, colicky in nature – 1wk Vomiting of gastric content – 1 day No flatus – 3days

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Case Presentation' - hedley-boone


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
case presentation

Case Presentation

Dr.MohammadAmin K Mirza

Saudi Board of Surgery

Holy Makkah, KSA

2008

history clinical data
History & Clinical Data
  • 34 y.o Saudi, female Pt, Married
  • Came to ER c\o:
  • Lt sided abdominal pain, colicky in nature – 1wk
  • Vomiting of gastric content – 1 day
  • No flatus – 3days
  • Passed hard stool – at the night prior to admission
  • H\O open appendectomy 1 yr back ( histopath: acute suppurative appendicitis)
  • No DM or HTN
history clinical data cont
History & Clinical Data cont..
  • O\E: Conscious, oriented, not toxic, not in destress
  • V.S: Temp: 37 C° , BP: 130/80 mmHg, HR: 96 bpm
  • Abdomen: Mild distension , soft lax no tenderness

Bowel sounds: Audible, hernail orifices – intact

  • CBC: normal Chemistry: K – 3.2 Na – 127
  • AXR: Distended small bowel, multiple fluid levels
managemaent
Managemaent
  • NPO
  • NGT
  • D5 ¼ NS 125 ml/hr
  • Inj KCl 60 meq \24 hr
  • Intake output chart
patient progress
Patient progress
  • She showed slow progress
  • Although she had no signs of peritonitis, sepsis, or any systemic response , there was no improvement regarding bowel movement , & she didn’t pass stool or fleatus
  • Correction of electrolytes was achieved on 3ed day of admession
laparoscopic exploration
Laparoscopic exploration
  • On 5th laparoscopic exploration was planned as the patient didn’t show any improvement although there was no any signs of systemic response
laparoscopic exploration1
Laparoscopic exploration
  • Dilated small bowel down to Rt colon
  • Severe adhesive process at RIF
  • Release of adhesions done
post operatively
Post-operatively
  • Patient is well & feeling good
  • Weak mobilization
  • No abdominal apin
  • No fever , tachycardia, or hypotention
  • Soft lax abdomen , mild destension
  • NGT 150-200 cc / 24hr
  • AXR – decreased gaseous distension
post operatively1
Post-operatively
  • Still didn’t pass stool or flatus
  • No vomiting ,
  • NGT – 1050-200 cc greenish
  • K 3.8
  • Postoperative ileus was considered & decided to start on erythromycin tab 500 mg BD
  • CT scan abdomen was arranged for next day
4 th day post operatively
4th day post operatively
  • Slow recovery : still no stool or flatus
  • BP: 120/70 ,, HR: 110 , T: 37.4
  • Patient is well generally, not toxic or destressed
  • Abdomen: Soft lax , mild distension, BS +ve
  • Na 134 K: 3.8
  • CT abdomen: adhesive process at RIF with obstruction at the ceacum !!!!!!!!!!!!
exploratory laparotomy
Exploratory laparotomy
  • 2 fibrous bands at the area of Lig. Of Treitz surrounding a segment of proximal ileum
  • It is 20 cm long segment , 60 cm away from ileoceacal junction
  • The segment is thickened adherent to posterior abdominal wall , with small perforation at mesenteric border.
  • Small amount of pus & fibrinous patches in peritoneal cavity
  • Resectio anastomosis done using GIA
post operative course
Post operative course
  • Smooth recovery
  • No fever
  • Oral intake started on 4th day post op
  • Passed stool on 5th day
  • Tolerated oral intake
  • Minimal superficial wound infection
  • Pus C/S no growth
  • Discharged in good condition 9th day post op
  • OPD follow up , clips removed
  • Histopath: acute inflammatory process.
medications
Medications
  • Erythromycin
  • Ceftazidime
  • Gentamycin
  • Metronidazole
  • Pantoprazole
  • Enoxiparin
adhesive small bowel obstruction

Adhesive Small bowel obstruction

Congenital & acquired bands

background
Background
  • Peritoneal adhesions can be defined as abnormal fibrous bands between organs or tissues or both in the abdominal cavity that are normally separated.
  • Adhesions may be acquired or congenital
causes
Causes
  • most common cause of is abdomino-pelvic surgery
  • inflammatory conditions
  • Intraperitoneal infection
  • Abdominal trauma
  • Intraperitoneal foreign bodies, including mesh, glove powder, suture material and spilled gallstones.
slide27

93% to 100% of patients who undergo transperitoneal surgery will develop postoperative adhesions.

  • Intraabdominal adhesions are the most common cause of SBO accounting for approximately 65% to 75% of cases
the risk of sbo is
The risk of SBO is
  • 1% to 10% after appendectomy.
  • 6.4% after open cholecystectomy,
  • 10% to 25% after intestinal surgery
  • 17% to 25% after restorative proctocolectomy
slide38

Gastrografin transit time may allow for the selection of appropriate patients for non-operative management.

  • Some studies have shown when the contrast does not reach the colon after a designated time it indicates complete intestinal obstruction that is unlikely to resolve with conservative treatment.
  • When the contrast does reach the large bowel, it indicates partial obstruction and patients are likely to respond to conservative treatment.
  • Although Gastrografin does not cause resolution of small bowel obstruction there is strong evidence that it reduces hospital stay in those not requiring surgery.