Getting busy again!
Wow! I am beat! After a month of quiet ward, my ward is suddenly packed with complicated problems. Am I complaining, well not really!
I was on call yesterday and as usual the call was eventful. To summarise, it was exciting especially for this three cases.
The first, was an on table referral from the obstetric team. This was about a pregnant lady who was at term with her pregnancy and suddenly presented to us for very severe abdominal pain. An emergency surgery was performed to deliver the big baby of 4kg. Surprisingly, her abdomen was completely normal except for this:
A common presentation in pregnant women. Her abdominal pain was caused by blocks or clusters of hard stools impacting her large intestine. Almost two thirds of her large bowel were packed and clustered with these hard stools.
Advice, please to all pregnant women, drink plenty of fluids, eat lots of fibres and if constipated get some laxatives.
Next, was a young lady in her teens who was involved in a road transport accident and this was her CTscan findings.( not clear - sorry!)
She had shattered her left kidney but luckily, she was very stable. Her case was taken over by the urology team.
The last but not least, this elderly lady presented with an bowel obstruction and had a large tense right lower abdomen mass. Her scans are as below. Care to make a guess?
Care to guess the last scans?
June 28th, 2007 at 9:52 pm
A busy ward indeed. Interesting post….learnt something again.
June 30th, 2007 at 7:11 am
huahhhh… interesting cases! Pity the patients though. I don’t know how to read nor understand the scans, or else I would be a doctor, wouldn’t I? hehehe….
I can cut up things very well.
June 30th, 2007 at 7:31 am
Busy…poor girl.
Is that galstone I see…or alot of food impacted up at the cavities?
June 30th, 2007 at 8:04 pm
The last set of CT scans actually shows a hugely dilated caecum and dilated large and small bowels. The cause — hah - will blog about it tomorrow
July 1st, 2007 at 6:12 am
Ohh .. that scary .. blocks of hard stools clogging the intestine!! Will you be taking those out surgically?
July 1st, 2007 at 6:14 am
Err .. no clue on the CT scans .. are we suppose to take a top view?
July 2nd, 2007 at 10:20 am
4kg is a very big baby!
July 3rd, 2007 at 4:46 pm
the surgery was a blessing in disguise. I agree 4kg is huge and poor lady would have died delivering the child vaginally.
July 3rd, 2007 at 5:07 pm
Fuyohh.. the most bloated caecum I’ve ever seen.
Psst.. what her secret to such strong caecal walls?
July 6th, 2007 at 6:21 am
Does all blogging surgeons pause in between surgery to snap a pix interesting findings in their patients inside.. URK!!!!
You didn’t mention how the hard stool was cleaned up though..
July 6th, 2007 at 5:28 pm
Bernard, ya lo should ask her!
Zara’s mama, well we have other staff to take shots for us. Anyway, all I did was to loosen those hard stones and gave her loads of laxatives and enemas to aid her passing them naturally. She did and was discharged a few days later.
October 31st, 2007 at 7:12 pm
4kg is about 9lb, I’ve delivered babies well over 10lb vaginally. They don’t die!
October 31st, 2007 at 8:50 pm
Student Midwife, the baby did not die and the post is not about the mode of delivery. The reason for operating on her was because of her severe abdominal pain which was thought to be an acute abdomen.