Post on 24-Feb-2016
description
Not All Turds are Created Equal
Not All Turds are Created Equal CC: Abdominal Pain HPI: 25 y old female. Presents with one day of
progressive abdominal pain. Generallized, progressive and constant pain. Sudden worsening of pain 2 hours ago. Associated nausea and vomiting. No fever. Bloating. Flatus.
LBM in am (“normal”) History of same problem one
month ago. Admitted to ERH. After Xrays and CT scan was given two bottles of Go-Lytley and discharged the following day.
Not All Turds are Created EqualPMH:
◦ Anorexia-bulemia◦ AKA due to severe
osteopenia and # non-union
◦ Prescription narcotic dependence
◦ Chronic constipation
Not All Turds are Created Equal Physical Exam: HR-120 BP-120/60
RR-18 T -36.7 Marked discomfort Chest: clear CVS: normal Abdomen:
Protruberant, BS+, generallized tenderness, guarding and reboundlarge right periumbilical mass (mobile)
Not All Turds are Created Equal
Xray
Not All Turds are Created EqualOne month prior
Not All Turds are Created Equal
Not All Turds are Created Equal
XrayCT
Not All Turds are Created Equal
Not All Turds are Created EqualXrayCTTreatment??
Stercoral PerforationDefinition:
“perforation of the large bowel due to pressure necrosis from a fecal mass”
Stercoral PerforationIncidence: 100
reported casesAge: 4y-85y
(mean=59y)Mortality: 35%History of
constipation: 60%Risk factors:
◦ NSAIDs, Antacids, Steroids, Narcotics
◦ Neurologically impaired patients
Stercoral PerforationDiagnostic Criteria
◦ Ovoid colonic perforation (antimesenteric)
◦ Fecalomas (within bowel or intraperitoneal)
◦ Pressure necrosis at perforation site
May be multiple sites of erosion/perforation (27% of cases)
Stercoral PerforationSites:
◦ Sigmoid (47%)◦ Rectum (30%)◦ Caecum (9%)◦ Transverse (7%)◦ Descending (5%)