A difficult abdominal case.

[Ioana Iftimie-Nastase]

I had a similar case a few months ago....a 52 y.o fem. patient that lived for 43 hrs postop. She had no history of cardiac arrhythmias, in fact she had been a pretty healthy woman till the moment she to our hospital with diffuse abdominal pain. 
In her case the infarction included the small bowel and the entire colon. 
Intubated, with heparin, morphine and proper fluid administration she lived for 43 more hrs after the postop diagnosis was established.


 
Ioana Iftimie-Nastase, MD, General Surgery-PGY 2
Bucharest, Romania
Cell phone:00-40-72-26-35-890 

--- On Thu, 7/10/08, rm khattar <dr_rm_khattar at yahoo.co.in> wrote:

From: rm khattar <dr_rm_khattar at yahoo.co.in>
Subject: A difficult abdominal case.
To: trauma-list at trauma.org
Date: Thursday, July 10, 2008, 6:28 AM

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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