ruptured diverticulitis
TRANSCRIPT
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Interesting case
5/2/2012
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Man, 77 years
. .
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History
Chief complaint
Abdominal pain 2 days PTA
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History
Present illness2 days PTA, he complained about dull
aching pain in abdomen. The pain wasmuch more at left side of abdomen.He had low grade fever, watery diarrheaand anorexia.
1 days PTA, the pain was not improved.He decided to go to Srinagarind hospital.
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History
No underlying disease
No drug allergy
S/P open appendectomy 7 years PTA
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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
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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
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Hb 12
Hct 36
WBC 18700
Plt 235000
PMN 92
L 5
M 1
Bun 46
Cr 2.3
Na 137
K 4
HCo3 27
Cl 100
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Imaging
Film acute abdomen series
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Male, 77 y/o
Provisional Dx
Localized peritonitis
Etiological Dx
Complicated diverticulitis>>ruptured
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Male, 77 y/o
What is next step? IV resuscitation
NG + foley catheter Empirical ATB
Prepare for Operative room
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Operation
Dx
Ruptured sigmoid diverticulitis
Procedure
EL, sigmoidectomy Hartmann Procedure
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Thank You