NOt true trauma but a cool abdo case

[Andrew J Bowman]

55 year old female. PMH of L1 paraplegia from fall off roof 20 years ago,
paranoid schizophrenia.

Had colonoscopy 2 days prior to ER visit for evaluation of "blood on tissue
paper".
Patient does not know details of procedure. (biopsy, problems, etc)
Presents with 2 days of increasing abdominal pain, bloating, nausea,
anorexia and dyspnea and decreased urine output.

Has not called her doctor or her GI doctor.

I find her to be awake and alert. Tachypneic at 32, pulse 120-130, BP 84/60.
Abdomen rounded, bloated, firm, diffusely tender and has loud tympany to
percussion. Foley placed with
50ml urine returned. Breath sounds clear and equal, ? slightly diminished.

Fluid resuscitation started with NS. Stat acute abdomen series.

Marked amount of free air with elevated diaphragm and downward and medially
displaced liver. Double colon wall sign noted.

BP came up with fluids. Still tachypneic but maintaining sats with nasal O2
at 4lpm.
Creatinine 2.5.

I called surgeon and he came in about 45 minutes after call and off to the
OR about 30 minutes later (team is on call for this small community
hospital). BP labile in ER waiting for surgeon. As low as mid-80's and as
high as 110 systolic. Heart rate always 110-120.

Nice tension pneumoperitoneum with presumed abdominal compartment syndrome.

Should I have done a bedside decompression with a DPL catheter???


Andrew

I will have images to share by Tuesday am (if the computer Gods are smiling)