Case Discussion

SMB obstruction 26/2/2012

FP1492
Sex Man Age 65 years Address Khon Kaen Occupation Admit 16/2/2012

History
Chief complaint Abdominal pain 6 days PTA

History
Present illness
6 days PTA, he complained with abdominal colicky pain. He had nausea & vomiting. He still had bowel movement. He went to clinic, doctor sent him to CT scan abdomen.

History
Present illness
1 days PTA, the pain was not improved. He still had nausea & vomiting. But he could not pass stool nor flatus. He decided to go to Srinagarind hospital.

History
No underlying disease No drug allergy No previous surgery

Physical examination
Looked distress from pain BT 37.4 PR 96 RR 20 BP 140/80 HEENT : not pale, no jaundice, LN-ve mild dry lips & tongue Heart : normal Lungs : normal

Head

Head

Physical examination
Abdomen
Distension, hypertympanic on percussion Generalized mild tenderness No guarding BS : decrease No mass

No groin hernia PR : empty rectum, no mass Groin : not seen hernia

Lab investigation
Hb =13.6 WBC=14,900 NE=89% BUN=13.5 Na=139 HCO3= 26 Hct= 41% Platelet=290,000 LY=7% Cr=1.5 K=3.5 Cl=103

UA = sp.gr 1.023, glc ve, wbc 1-2

Man, 65 years
Provisional Dx DDx

Complete distal small bowel obstruction

Volvulus Meckel band Adhesion band Malignancy

Man, 65 years
Imp
Complete small bowel obstruction (adhesion band from mesenteric adenitis)

Procedure

EL, lysis adhesion, LN biopsy

Pathological finding
S 5502284
Mesenteric LN

Fibrosis & chronic inflammation of mesentery 1 LN = no specific disease, no granuloma

Thank You