A complicated case of diarrhoea
| Autor: | K Ewins, S Vandermolen, Saman Perera, J Wright, Farhad Huwez |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Aged
80 and over Diarrhea Male Resuscitation medicine.medical_specialty Abdominal pain Erythema business.industry Acute kidney injury Rectum General Medicine Diverticulum Colon medicine.disease Anus Abscess Anti-Bacterial Agents Surgery Colonic Diseases medicine.anatomical_structure medicine Vomiting Humans Abdomen medicine.symptom business |
| Zdroj: | BMJ. 348:g2172-g2172 |
| ISSN: | 1756-1833 |
| DOI: | 10.1136/bmj.g2172 |
| Popis: | An 82 year old man presented with a six day history of watery diarrhoea, vomiting, abdominal cramps, and confusion. He had a history of hypertension, gout, and prostate cancer, which was well controlled on hormonal therapy. He was independent and lived alone. He had not travelled or used antibiotics within the past two months. On examination he appeared dehydrated, but was haemodynamically stable and afebrile. His abdomen was soft and non-tender, with normal bowel sounds. He had some erythema around the anus. The rectum was empty on digital examination. Initial investigations showed a raised C reactive protein (178 mg/L, reference range 0-8; 1 mg/dL=9.52 nmol/L) and acute kidney injury (creatinine 125 µmol/L, 60-130; 1 µmol/L=0.01 mg/dL; urea 16.6 mmol/L, 2.3-6.7; 1 mmol/L=2.8 mg/dL). He was also noted to be hypokalaemic (potassium 3.0 mmol/L, 3.5-5.3). A plain abdominal radiograph was normal. Stool was negative for Clostridium difficile toxin but stool culture grew Campylobacter jejuni . He was managed supportively with fluid resuscitation and received oral erythromycin 250 mg four times daily for five days. Diarrhoea became less frequent, but he remained unwell with persistent abdominal pain, persistently raised inflammatory markers, and renal dysfunction. He developed a palpable mass in the left iliac fossa. Abdominal computed tomography (figure⇓) showed numerous outpouchings of the colon (arrow 1), with fatty stranding (arrow 2), which suggested acute inflammation. An irregular fluid collection containing an air bubble was also seen along the sigmoid descending junction (arrow 3). Abdominal computed tomogram showing numerous outpouchings of the colon (arrow 1), with fatty stranding (arrow 2), and an irregular fluid collection containing an air bubble along the sigmoid descending junction (arrow 3) |
| Databáze: | OpenAIRE |
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