Case DiscussionSMB obstruction

26/2/2012

FP1492

• Sex Man• Age 65 years• Address Khon Kaen

• Occupation –• Admit 16/2/2012

History

• Chief complaintAbdominal pain 6 days PTA

History

• Present illness6 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 illness1 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 Hct= 41%WBC=14,900 Platelet=290,000NE=89% LY=7%

• BUN=13.5 Cr=1.5Na=139 K=3.5HCO3= 26 Cl=103

• UA = sp.gr 1.023, glc –ve, wbc 1-2

Man, 65 years

• Provisional Dx– Complete distal small bowel obstruction

• DDx– 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 mesentery1 LN = no specific disease, no granuloma

Thank You