A Lethal Rare Event
A 49 year old Indian gentleman presented to my practise with a 5 day complaint of progressively increasing abdominal pain which started around the umblicus and on the day of admission the pain was present all over the abdomen. This was associated with nausea and vomiting. He also noted his abdomen progressively increasing in size and was not able to pass motion. He was having spiking temperature and was very dehydrated. He had diabetes and hypertension and was also a heavy smoker. There has been previous episodes of central abdominal pain which lasted mostly for 2 to 3 days and colicky in nature. However, the wife noted that his abdominal pain increased in frequency recently and worsened after meals. He was resuscitated and an emergency laparotomy was performed. These was what I saw:
Mind to make a guess?
PS: For those who read “Burnt” , the 17 year old boy passed away yesterday!
October 28th, 2006 at 5:51 am
Cham liao…. gangrene already. Mesenteric artery thrombosis or embolus. Got AF or not?
Resect or close?
October 28th, 2006 at 6:53 am
ya la..wat u did then?…poor guy..survival rate?…
October 28th, 2006 at 9:03 am
so teruk one ah? why like this? diabetes and smoking is it? necrosed intestines? wah, this fella will die soon? donno about this
October 28th, 2006 at 2:54 pm
Ohhh … the intestines turned black!! Can he survive?
October 28th, 2006 at 4:16 pm
Bernard, his pulses were fast but of normal rhythm. That was exactly what I thought until I thought I felt the mesenteric pulses -feeble and very oedematous mesentery. The bowel itself was dilated with no peristaltic activity and did not revert even with placement of warm packs!
Thanks everyone for the interest. Will continue on him tomorrow! Mesentery is a fatty layer that holds the intestine and carries the blood and lymphatic drainage to and from the intestine.
What would you do? Resect or close?
October 30th, 2006 at 3:49 am
Depend on the finding, if got no viable gut left.. i guess there’s not much to do except close.