20110812_Viêm ruột thừa thể tắc đại tràng

20110812_Viêm ruột thừa thể tắc đại tràng


this old patient had abdominal pain and distension and inability to break wind within 2 weeks upon his admission, we diagnosed a case of colonic obstruction CT scan showed signs of obstruction at sigmoid colon on CT scan, sigmoid colon shows no clear evidence of tumor but its wall is thicken in a considerable distance our diagnosis preoperatively is obstruction of sigmoid colon. After abdominal wall is openned, we see gut distended small intestine is moderately distended pelvic region has pseudo-menbrane small intestinal loops at pelvis have pseudo-menbrane thick pus is collected with considerable amount in pelvic region see ít ? (ask cameraman) we are looking for the etiology of these (lesions) we are making blunt dissection dissecting small intestinal loops…what is the cause of this pelvic peritonitis ? appendix ! damn it ! is it right ? appendix !…oh damn ! it here….is it right ? is it secondary (appendicitis) ? …looking again… it is true. Appendix is lying here.. lying right at pus cavity ?…uhm (slaughing) appendix looks normal…oh no…it is perforated…wiping it… wiping… our diagnosis is not correct….from intestinal obstruction it turns out to be peritonitis…gangrene here appendix here ok…it is the appendix… this appendix is gangrenous it is gangrenous and being perforated here …(stammering)…give me a gauze if it is true appendix (appendicitis), I have seen 4 cases from graduating till now 4 cases of ileus manifestation of appendicitis. All 4 cases have not been diagnosed preoperatively this appendix is lying on the surface of sigmoid colon do you film this site ? (said to cameraman) see the hole ? it is lying on sigmoid colon so on clinical examination, this patient has colonic obstruction syndrome colon distension is prolong to sigmoid (colon) inflammed appendix which is at normal location making distension only to small intestine ileus manifestation is confined only to small intestine patient with no abdominal scar, syndrome of small intestinal obstruction, right lower quadrant pain mandates diagnosis of ileus manifestation of appendicitis this kind of diagnosis is reasonable in this case, appendix is within pelvis, lying on sigmoid colon it is making ileus…colonic obstruction it is the only case of appendicitis which manifests as colonic obstruction… as I know ileal loops at pelvis are caked I would detach them removing all pseudo-menbranous tissue checking for continuity of gut gut is in bad condition it is two weeks abdominal pain and distension is prolonged by two weeks no one thought about it (diagnosis) preoperatively patient has no fever

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