Feb 4, 2010

Acute appendicities

One 16 yrs old female presented with sudden, severe pain around umbilicus along with gastric vomiting. Later on the pain shifted to right side of lower abdomen. She started having frequency of urination. Looking at her condition she was directly admitted in surgical ward. The plain x-ray abdomen showed 2-3 air fluid levels in right lower part of x ray. rest of the parts were normal. Ultrasonography abdomen showed swollen, tubular & tender structure in right iliac fossa.There were dilated bowel loops & minimal fluid in the same site, most probably appendicitis (whenever the ultrasonologist can see the appendix that means it is acutely inflamed, otherwise in majority of the cases, appendix could not be located & there is only probe tenderness). Both the ovaries & adnexae were normal (this is very important in female patients). Total leukocyte counts were high with predominance of neutrophils (S/O infection).

As it was the case of acute appendicitis, patient was immediately taken for surgery. On exploration there was long, inflamed, swollen appendix going into pelvis. There were lot of bowel adhesions & whole area was edematous. But there was no perforation. Rest of the bowel was normal. Ovaries were normal. Appendix removed after ligating & cutting appendicular mesentery. Abdomen sutured in layers.

Patient was kept nil by mouth for 24 hours till abdomen became soft, she passed flatus & bowel sounds became normal. She was started on oral fluids followed by solids & discharged on third day.Subcuticular suture removed on day 7. The wound was perfectly healed.

Feb 3, 2010

Small Intestinal obstruction

A 4 yrs old child is presented with vomiting & pain in abdomen. Initially, vomiting were whitish/or food taken then later on vomitings became yellowish. The child was having severe pain in abdomen. Abdomen was distended. There was tenderness (pain on palpation) all over abdomen. Bowel peristalsis were sluggish.

X-ray abdomen in standing position revealed multiple air fluid levels. Ultrasonography abdomen shows dilated bowel loops with sluggish peristalsis. Minimal fluid was present in peritoneal cavity.All these investigations typically suggestive of intestinal obstruction.

Child was posted for surgery.On exploration there was small intestinal volvulus with a band crossing & obstructing.The band was nothing but a part of small intestine. Once the volvulus derotated & small intestinal band released, obstruction relieved. Some portion of bowel involved in volvulus was looking bluish & preischaemic. After putting hot mops, giving 100% oxygen, the bowel color changed. After inspecting all intestine and other structures in abdomen, abdomen closed in layers.

The child was kept nil by mouth for 48 hours within this period the bowel sounds returned & child passes gases. Then slowly water, liquids introduced & once child started tolerating soft died the child was discharged.