What?? This ain’t no appendix II
A young boy of 15years old presented with a 2 day history of abdominal pain starting at the upper abdomen(epigastrium) then later the pain was worse felt over the right lower flank. He was diagnosed to have appendicitis.
I got a call from my medical officer saying that he drained 400mls of dark haemoserous fluid from his Lanz incision made for appendectomy. We converted the case to perform a laparotomy and this is what we found.
After releasing the twist,
It is a case of mesenteric venous thrombosis secondary to volvulus of the mid-segment of the small bowel. Maybe also it could be a internal herniation from a congenital band.
After the resection, he is left with probably 90cm of small bowel from about 250 to 300cm of small bowel.
Related post:
What?! This ain’t no appendix
July 22nd, 2007 at 5:28 am
fantastic shots! poor boy!
July 22nd, 2007 at 9:23 am
OMG! Hideous! Poor boy!
er…. is there any simpler terms for laywomen like me?
July 22nd, 2007 at 11:44 am
looks a bit like yin and yang on the second picture eh? I think the boy is lucky enough to have this sorted out before fulminant sepsis…but alas had to have a HUGE portion of his bowel out…
July 22nd, 2007 at 4:54 pm
So sad that he has to live the rest of his life with such a short bowel - there’s bound to be complications from that later on. But the good news is, at least he’s still alive…
July 22nd, 2007 at 6:16 pm
What was the whole lot of dark redish thing taken out (picture #1)? Excuse my ignorance but I am curious to know.
Secondly, now that his bowel is drastically shortened, does that mean that he will always need to go to the toilet more often than before?
Thirdly, what causes the bowel to be twisted? Surely it didn’t happen overnight?
July 23rd, 2007 at 6:24 pm
Thanks nocturnale.
ECL, well this boy’s small intestine got twisted like a butterfly knot and was because of that the segment of small intestine became congested as blood was not able to flow out. Not just congested, it became swollen and blood filled the lumen and stained the wall red. As it continues to get congested and swollen, blood supply is further compromised and the segment of intestine becomes dusky and later die. This is what happened and thus the reason to remove the unhealthy segment.
July 23rd, 2007 at 6:33 pm
Docperineum and shah, thanks. He is alive and since he is young I think he should continue without much set backs.
Hi Judy,
1. That is the dead and congested small intestine which is not viable anymore. (refer comment earlier). The bowel was stained by the blood congested to the lumen and its lumen was filled with foul smelling blood.
2. No the issue is not about going to toilet more often. In fact, it may be normal. The issue is that whether the length left is adequate for him to absorb all the nutrition he needs. That is the worry and therefore he would require a special diet called elemental diet which can be adsorb easily and fast from the small intestine. Hopefully, the small bowel grows a little more as he grows. He is 15.
3. This is the question that still haunts me. There was nothing leading in the history . The other possibility is of an congenital ( since birth) band causing the bowel to go through and get twisted.
July 23rd, 2007 at 11:28 pm
George, thank you for taking the time to explain. How mysterious our body organs are. This has been very educational for me.
As you mentioned that hopefully the boy’s bowel will grow as he gets older, I will now pray that his bowel will grow and that he will not have to stick to restricted diet.
August 5th, 2007 at 4:55 pm
He has been discharged and appears to be able to tolerate normal adult diet.