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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