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CaseStudy241116 -

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24 Nov 2016 - General

A middled aged gentleman, with the background of hypertension, asthma, hypercholesterolaemia, smoker of 10 pack years history, was admitted to hospital due to worsening right sided abdominal pain, and diarrhoae. According to patient, she experinced acute onset of right sided abdominal pain around 4 days ago, which was followed by waterry diarrhoae. Initally, the abdominal pain was relieved by analgesia - paracetamol. However, the right sided abdominal pain was worsening since a day before, with rate 8-9 / 10. She also has waterry diarrhoea around 6-7 episodes per day, since the onset of abdominal pain. On examination of her abdomen, abdomen was very tender and with rebound tenderness. Urgent CT-ABD & Pelvis was done (to rule out intra-abdominal pathology or perforation), showed likely mild pancolitis. There was no bowel perforation. Her blood tests showed elevated white cell count and inflammatory marker. What is your working diagnosis ?? What other investigations are neeeded??

GASTROENTEROLOGY

Yes Marinelle Castro , performing a full colonoscopy for patient with acute colitis may be risky due to the higher risk of bowel perforation. If endoscopy procedure is really required, then a flexi-sigmoidoscopy will the option, rather than the full colonoscopy. However, in this case, given the history of acute onset of abdominal pain and diarrhoea, the aetiology would be most likely an infective cause, causing i...

(Total 121 words)

Others

You Yi Hong From what I learned in medical school, performing endoscopy on a patient with diffuse inflammation of the bowel increases the risk of bowel perfortation. For this reason, I have my reservations with regards to having a flexible sigmoidiscopy for this patient. If imaging was negative for appendicitis, then the next differential diagnosis would be inflammatory bowel disease. If the patient does not hav...

(Total 113 words)

GASTROENTEROLOGY

Yes Marinelle Castro &Mark Edmon Tan , acute appendicitis / rupture appendix / appendiceal abscess is definitely the crucial diagnosis to be ruled out first in this case. The CT ABD scan was reviewed in detail, which showed no evidence of acute appendicitis or abscess or rupture on the scan. Appendix appears to be normal on t...

(Total 124 words)

Physical Medicine and Rehabilitation

I just remembered what criteria we used during my duty days in the Emergency Room. It's called the Alvarado score or the MANTRELS Criteria. The score has 6 clinical items and 2 laboratory measurements with a total 10 points. MANTRELS is a mnemonic for- Migration to the right iliac fossa, Anorexia, Nausea/Vomiting, Tenderness in the right iliac fossa, Rebound pain, Elevated temperature (fever), Leukocytosis, and Shift of neutrophils to the left. A score of 5 or 6 is compatible with the diagn...

(Total 108 words)

Others

You Yi Hong I have encountered similar cases, and there is a possibility that this is a case of an intraabdominal abscess caused by a ruptured appendicitis. The patient had a history of right lower quadrant pain since for days ago followed by watery diarrhea. The persistent watery diarrhea accompanied by leukocytosis signifies that there is a diffuse inflammation of the bowel. On the background of a right sided ...

(Total 110 words)

Physical Medicine and Rehabilitation

This sounds like a case of acute abdomen secondary to appendicitis. Acute severe abdominal pain is one of the hallmark symptoms of appendicitis. The other common symptoms are anorexia, nausea, and temperature elevation. The acute abdominal pain usually starts as a generalized type before localizing to the right lower quadrant of the abdomen. The elevated white cell count and inflammatory markers are also a clue of ongoing infection As for the result of the CT of abdomen and pelvis, inflammation ...

(Total 115 words)

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