A rare presentation of an acute abdomen: an ileal diverticular perforation
| Autor: | Sanjay de Mel, J. Hewavisenthi, Lal Chandrasena, Chandima de Mel, Basuru Uvindu Thilakawardana, V. Abeysuriya, Visula Abeysuriya |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male Abdominal pain medicine.medical_specialty Ileal Perforation medicine.medical_treatment lcsh:Medicine Case Report General Biochemistry Genetics and Molecular Biology Diagnosis Differential 03 medical and health sciences 0302 clinical medicine Laparotomy medicine Humans Diverticular Laparoscopy lcsh:Science (General) lcsh:QH301-705.5 Abdomen Acute Ileal Perforation medicine.diagnostic_test business.industry Ileal Diseases lcsh:R General Medicine medicine.disease Appendicitis Surgery Meckel Diverticulum lcsh:Biology (General) Acute abdomen Intestinal Perforation 030220 oncology & carcinogenesis Abdominal examination Diverticular disease 030211 gastroenterology & hepatology Radiology medicine.symptom business lcsh:Q1-390 |
| Zdroj: | BMC Research Notes, Vol 10, Iss 1, Pp 1-3 (2017) BMC Research Notes |
| ISSN: | 1756-0500 |
| Popis: | Background This case report highlights the value of prompt intervention of diagnostic laparoscopy in a patient suspects of having an acute abdomen due to an intestinal perforation, where there is a limitation of performing Contrast Enhanced Computed Tomography of abdomen. A previously healthy young adult presenting with an acute abdomen due to a spontaneous ileal perforation, without any associated risk factors is a rare clinical entity in a developing country. Therefore, entertaining an early diagnosis will possibly prevent a fatal consequence. Case presentation A male patient, 29 years old, recently diagnosed as a young hypertensive without any associated factors, currently on antihypertensive treatment, was admitted to our hospital presenting with an acute severe abdominal pain. During initial assessment, the patient was febrile (101 °F), ill looking, tachycardic (pulse rate 121 bpm) with rapid shallow breathing. Abdominal examination reviled diffuse guarding and rigidity, more severe on right iliac fossa. Following history and clinical examination probable clinical diagnosis was made as an acute appendicitis with perforation. However, ultrasonography was found to have normal appendix. Contrast Enhanced Computed Tomography was not performed as a subsequent investigation because of the impairment of renal functions of this patient. Though, non-contrast CT would have been ascertained more diagnostic yield, given the critically ill status of this patient we decided to perform urgent diagnostic laparoscopy. It reviled pus in several abdominal cavities and dense adhesions. Therefore, the procedure was converted to a laparotomy and found to have an ileal perforation with diffuse peritoneal contamination. Diseased ileal segment was resected and anastomosed. Followed by peritoneal lavage. Conclusion Ileal perforation due to diverticular disease in a healthy young adult is rare. This case report highlights the importance of considering this clinical entity as a differential diagnosis, the value of early diagnostic laparoscopy, especially in clinical settings with limitations to CT scan, since late diagnosis can give rise to fatal outcome. |
| Databáze: | OpenAIRE |
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