A difficult abdominal case.

[rm khattar]

The CT which he has brought from the Govt. facility shows normal Pancreas.We do his amylase and lipase which are normal. Erect abdomen radiograph does not reveal any free gas under right diaphragm but has air fluid levels in upper abdomen.After coming to us he starts deteriorating rapidly.Bedside USG does not reveal gall stones,only moderate fluid in abdomen.
He undergoes Laparotomy,within few hours of arriving at our facility. 2-3 litres of brownish fluid is removed and except 3 feet of jejunum,the entire small bowel is gangrenous,the gangrenous involvement is frank except for terminal bowel which has patches of full thickness gangrene,the caecum ,ascending colon and hepatic flexure has similar findings.There is sharp demarcation detween vascularized and nonvascularized bowel at jejunal and colonic ends.Even the mesentry appears black in the involved areas.Beyond hepatic flexure colon apperas well perfused.
What would you have done in such a situation?
Apolgise for delay ,in answering.
R.M.Khattar,Delhi


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