CLINICAL SCENARIO IN SURGERY-1

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Hi hive people,its my pleasure to meet you all again.now i am going to tell about some clinical entities that we can see in surgery.i am going to explain with clinical scenarios.

CLINICAL SCENARIO - 1

A LADY UNDERWENT A LEFT HEMICOLECTOMY FOR COLON CANCER 5 DAYS BACK.SHE NOW COMPLAINS OF ABDOMINAL DISCOMFORT AND BLOATING.SHE IS STILL UNABLE TO PASS GAS.O/E,THE ABDOMEN IS DISTENDED AND NO BOWEL SOUNDS ARE HEARD.X-RAY SHOWS GAS-FILLED LOOPS OF THE INTESTINE WITH MULTIPLE AIR FLUID LEVELS.WHAT IS THE DIAGNOSIS?

The answer is - "PARALYTIC ILEUS"

APPROACH -

It is post- op case after 72 hrs of laparotomy with no passage of flatus,absent bowel sounds,and x-ray findings suggests PARALYTIC ILEUS

It is an adynamic/functional obstruction in which there us failure of transmission of peristaltic waves.as there is no contractions so there is no colicky pain.

So this stasis leads to -
1.abdominal discomfort
2.vomiting
3.absence of bowel sounds
4.absolute constipation

If any of the following will be observed after 72 hrs of laparotomy then it is said to paralytic ileus -

1.no return of bowel sounds on auscultation
2.no passage of flatus

X- ray findings - gas-filled loops
With multiple air fluid levels

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Image source

CT scan is also done

MANAGEMENT -

1.Nasogastic tube decompression
2.restriction of oral intake until bowel sounds and the passage of flatus return
3.Electrolyte balance must be maintained

The return of normal motility post-surgery occurs in the following sequence -

  • Small intestine(within the first 24 hrs) - Stomach(withing 48 hrs) -Colon(3 to 5 days)

Thanks for putting your time in looking at my post.

With regards,



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