History of Present Illness:
A woman in her mid-40’s with a history of DM and prior laparotomy for trauma presents to the hospital with one day of generalized abdominal pain, 8 days of mild mid-cycle vaginal bleeding and 2 weeks of subjective fevers. She denies any vomiting but is nauseated. She does not know what they did in her surgery. She denies other complaints
Vital Signs & Physical Exam:
Vital signs are normal. Abdomen is distended and tender with guarding and rebound
Initial Diagnostic Testing:
- CBC: WBC 18, platelets 990,000
- Chem: bicarb 11, gap 21, glucose 550, lactate normal
- Imaging: see below
What is the most likely diagnosis?
- A) Stool impaction
- B) SBO
- C) Intestinal perf
- D) TOA
SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT
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ANSWER:
- A) Stool impaction
- B) SBO
- C) Intestinal perf
- D) TOA – CORRECT
1-Minute Consult on this topic: Click HERE and scroll to page 110.
CASE CONCLUSION: CT showed massive TOA with gas formation and pneumoperitoneum. However OR diagnosis was an infected endometrioma. She had a bilateral salpingo-oophorectomy. She was on pressors for a few days but eventually did well.
