This morning I examined a post op patient who had a c/section 2 days ago. She had difficulty breathing, was febrile with a distended abdomen and rebound tenderness on exam. I scanned the patient and found that she didn't have any significant amount of fluid in the abdomen or pelvis so we treated her as severe peritonitis with broad spectrum antibiotics.
A moment later, I was called to do an emergent ultrasound on a patient admitted in the female medical ward. She was admitted with severe constipation, nausea and vomiting and she too had a distended abdomen with rebound tenderness. Her scan revealed a normal size uterus with what appeared to be a small intrauterine gestational sac without a fetal pole or yolk sac. There was a small adnexal mass and significant amount of free fluid in the cul de sac. I took her to the OR for laparotomy expecting to find a ruptured ectopic or ruptured hemorrhagic ovarian cyst. However, on opening we found diffuse, grossly dilated loops of small bowel with diffuse adhesions throughout the abdomen and pelvis - an acute small bowel obstruction. We ran the bowel and found a small area of ischemia however, no gross devitalized or necrotic tissue, so we performed extensive lysis of adhesions and closed. She'll get a nasogastric tube for at least 48 hours and conservative therapy post op.
The maternity ward was busy. I performed a cesarian section this morning on a patient with cephalopelvic dispraportion (CPD). It was her first pregnancy and she was lucky to have come to the hospital in time to be evaluated before potentially ending her pregnancy with a bad outcome!
More to come...
A moment later, I was called to do an emergent ultrasound on a patient admitted in the female medical ward. She was admitted with severe constipation, nausea and vomiting and she too had a distended abdomen with rebound tenderness. Her scan revealed a normal size uterus with what appeared to be a small intrauterine gestational sac without a fetal pole or yolk sac. There was a small adnexal mass and significant amount of free fluid in the cul de sac. I took her to the OR for laparotomy expecting to find a ruptured ectopic or ruptured hemorrhagic ovarian cyst. However, on opening we found diffuse, grossly dilated loops of small bowel with diffuse adhesions throughout the abdomen and pelvis - an acute small bowel obstruction. We ran the bowel and found a small area of ischemia however, no gross devitalized or necrotic tissue, so we performed extensive lysis of adhesions and closed. She'll get a nasogastric tube for at least 48 hours and conservative therapy post op.
The maternity ward was busy. I performed a cesarian section this morning on a patient with cephalopelvic dispraportion (CPD). It was her first pregnancy and she was lucky to have come to the hospital in time to be evaluated before potentially ending her pregnancy with a bad outcome!
More to come...
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