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Re: Interesting puzzling case- part 3 From: Richard Chudacoff, MD (rchudacoff@mylinuxisp.com) Thu Aug 31 14:32:39 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Myer Bornstein: "Re: Interesting puzzling case" Previous message: D. Ashley Hill: "Re: Interesting puzzling case" was there any mention of appendix on the initial path report when you operated on the endo? -- Richard Chudacoff, MD, FACOG -sent from my Treo 650 -----Original Message----- From: ENDODOK@aol.com Subj: Re: Interesting puzzling case- part 3 Date: Thu Aug 31, 2006 1:18 pm Size: 1K To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> 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 Next message: Myer Bornstein: "Re: Interesting puzzling case" Previous message: D. Ashley Hill: "Re: Interesting puzzling case"

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