Interesting case

5/2/2012

Man, 77 years
. . -

History
Chief complaint
Abdominal pain 2 days PTA

History
Present illness
2 days PTA, he complained about dull aching pain in abdomen. The pain was much more at left side of abdomen. He had low grade fever, watery diarrhea and anorexia. 1 days PTA, the pain was not improved. He decided to go to Srinagarind hospital.

History
No underlying disease No drug allergy S/P open appendectomy 7 years PTA

Physical examination
Elderly woman, looked distress from pain BT 38.5 PR 90 RR 20 BP 110/76 HEENT : not pale, no jaundice, LN-ve Heart : normal Lungs : normal

Physical examination
Abdomen
Distension Generalized mild tenderness Maximal point of tenderness at LLQ + guarding no guarding BS : normal

Ext : no edema PR : empty rectum, no mass Groin : not seen hernia

Hb 12
Hct 36

Bun 46

Cr 2.3
Na 137 K4 HCo3 27

WBC 18700 Plt 235000 PMN 92 L5

M1

Cl 100

Imaging
Film acute abdomen series

Male, 77 y/o
Provisional Dx
Localized peritonitis

Etiological Dx
Complicated diverticulitis>>ruptured

Male, 77 y/o
What is next step?
IV resuscitation NG + foley catheter Empirical ATB Prepare for Operative room

Operation
Dx
Ruptured sigmoid diverticulitis

Procedure
EL, sigmoidectomy Hartmann Procedure

Thank You