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A rare presentation of an acute abdomen: an ileal diverticular perforation
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...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5457724/ https://www.ncbi.nlm.nih.gov/pubmed/28578700 http://dx.doi.org/10.1186/s13104-017-2514-z |
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author | Thilakawardana, Basuru Uvindu De Mel, Sanjay Abeysuriya, Vasitha Hewavisenthi, Janaki De Mel, Chandima Chandrasena, Lal Abeysuriya, Visula |
author_facet | Thilakawardana, Basuru Uvindu De Mel, Sanjay Abeysuriya, Vasitha Hewavisenthi, Janaki De Mel, Chandima Chandrasena, Lal Abeysuriya, Visula |
author_sort | Thilakawardana, Basuru Uvindu |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-5457724 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-54577242017-06-06 A rare presentation of an acute abdomen: an ileal diverticular perforation Thilakawardana, Basuru Uvindu De Mel, Sanjay Abeysuriya, Vasitha Hewavisenthi, Janaki De Mel, Chandima Chandrasena, Lal Abeysuriya, Visula BMC Res Notes Case Report 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. BioMed Central 2017-06-02 /pmc/articles/PMC5457724/ /pubmed/28578700 http://dx.doi.org/10.1186/s13104-017-2514-z Text en © The Author(s) 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Case Report Thilakawardana, Basuru Uvindu De Mel, Sanjay Abeysuriya, Vasitha Hewavisenthi, Janaki De Mel, Chandima Chandrasena, Lal Abeysuriya, Visula A rare presentation of an acute abdomen: an ileal diverticular perforation |
title | A rare presentation of an acute abdomen: an ileal diverticular perforation |
title_full | A rare presentation of an acute abdomen: an ileal diverticular perforation |
title_fullStr | A rare presentation of an acute abdomen: an ileal diverticular perforation |
title_full_unstemmed | A rare presentation of an acute abdomen: an ileal diverticular perforation |
title_short | A rare presentation of an acute abdomen: an ileal diverticular perforation |
title_sort | rare presentation of an acute abdomen: an ileal diverticular perforation |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5457724/ https://www.ncbi.nlm.nih.gov/pubmed/28578700 http://dx.doi.org/10.1186/s13104-017-2514-z |
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