A difficult abdominal case

[rm khattar]

A 40 year man is admitted with 5days history of abdominal pain ,inability to pass flatus and motion,distention of abdomen and vomiting. No significant past history. On examination he is mildly dehydrated ,looks sick,and has tachycardia and looks in agony and has tender hugely distended abdomen with absent bowel sounds. There is redness on abdominal wall in both flanks. He has a indwelling urinary catheter draining concentrated urine, Ryle's tube in situ with whitish aspirate.His TLC,Urea ,Creatinine are high and he has mild  non obstructive jaundice,biochemically.He is carrying a CECT abdomen  from the hospital where he was previously admitted which shows intraperitoneal fluid and diagnosis of SBO.
What are the diagnostic possibilities?
What is the further work up?
What treatment should be offered?
R.M.Khattar
Delhi,India
Consultant Surgeon.  


      Bring your gang together. Do your thing. Find your favourite Yahoo! group at http://in.promos.yahoo.com/groups/