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follow-up post-op ileusFrom: David Hunter (hunter.d@ghc.org)Sun Jun 29 02:19:32 1997
summary: 45 yo with hx laxative abuse readmitted one week after tah/bso with painful abd distension, n&v; discharged after 3 days with brief episode of flatus and decreased pain/distension; followed for intermittent n&v, distension; enemas, bisacodyl not helping. members of the list suggested gen surg consult, possible hematoma, abscess, narcotic overuse. her vaginal exam was benign, wbc and hct both normal and stable; no use of narcotics after readmission. gen surg suggested trial of reglan followed by imaging if no prompt resolution. she stopped reglan after just two doses because of cramping. upper gi consistent with sbo. readmitted for ex-lap on post-op day 16. findings: clear junction point of proximal dilatation and distall normal small bowel, consistent with physical obstruction but no apparent adhesions, though serosa inflammed. our best explanation was that the very act of bringing that segment to the abd surface for examination released the adhesions. the surgeon kindly offered the suggestion that this finding is consistent with pt's intermittent hx: filmy adhesions forming, breaking, then reforming. with ng tube, iv hydration, no other pharmacologic intervention, pt reported first flatus, then frequent loose stools on post op day #6. home the next day with deceased but still present distension, tolerating fluids. thanks for your comments. david hunter, md, tacoma, wa
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