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Re: Interesting puzzling case- part 3From: ENDODOK@aol.comThu Aug 31 13:13:56 2006
Upon admission pt started on parenteral antibiotcs. Repeat CT with contrast demonstrated "Inflammatory exudate adjacent to multple loops small bowel", no indication of bowel perforation, no site of abscss, all other strutures normal". Remember , except for temp elevation and leukocytosis, abdomen negative for tenderness ,guarding, rebound, and BS wnl. Pelvic negative for abnormal findings. 8 hours after CT, Pulse up to 122, systolic pressure down to 95, O2 sat 85%. Pt appears septic, 1+ tenderness LLQ, no guarding or rebound. Exploratory lap with gen surgeon reveals a gangrenous perforated appy with inflammatory exudate. Appy located deep in pelvis, midline, with severe inflammatory reaction on the rectosigmoid . Small bowel and upper abdomen no pathology. Culture + pseudomonas. Pt afebrile in 24 hours, WBC 11,000, passing gas today. This was a good lesson in the possible presentation of markedly atypical appendicitis. Glenn Bradley
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