20

Case 20


History



A 21-year-old lady with a past history of developmental delay and mental retardation is admitted for coffee ground vomiting. She has had multiple readmissions for a similar problem. She has normal bowel motions and flatus. There is no other significant past medical history.


Physical examination


Afebrile, pulse 72 bpm, BP 115/80mmHg, SaO2 98-100% on RA.


Hydration is satisfactory.


Examination of the hands reveals no clubbing and normal-appearing palmar creases.


Head and neck examination is unremarkable.


Cardiovascular: HS dual, no murmur.


Her chest is clear on auscultation.


Abdominal examination reveals a distended abdomen, but no frank peritoneal signs could be elicited. Bowel sounds are sluggish.


No signs of oedema.


Investigations


CBC:


WBC 9.9 x 109/L;


haemoglobin 13.1g/dL;


platelets 289 x 109/L.


Electrolytes are grossly normal.


Bone profile is normal.


Amylase 113 IU/L.


pH 7.43.


BE -2.


sTSH 3.78mIU/L.


An abdominal X-ray is also performed (Figure 20.1).






images


Please describe what you see


There are markedly dilated large bowel loops.


What is your differential diagnosis?


Mechanical:


Large bowel intestinal obstruction.


Colonic volvulus.


Non-mechanical:


Only gold members can continue reading. Log In or Register to continue

You may also need

Oct 23, 2019 | Posted by in GASTROENTEROLOGY | Comments Off on 20
Premium Wordpress Themes by UFO Themes