A spectacular discovery
- PDF / 164,203 Bytes
- 2 Pages / 595.22 x 842 pts (A4) Page_size
- 87 Downloads / 179 Views
328 Hellenic Journal of Surgery 2012; 84: 5
A Spectacular Discovery Clinical Disputes and Pictures in Surgery I. Nikolopoulos, At. Kirresh, A. El. Gaddal Received 02/05/2012 Accepted 26/06/2012
Abstract This case study highlights the importance of a concise and accurate history. The patient was referred by the accident and emergency department as a bowel obstruction case likely secondary to displaced abdominal stent. After assessment by the surgeons, and further questioning and clinical examination, the correct diagnosis was established.
History This 78-year-old gentleman presented to the Accident and Emergency department with a one-day history of generalised abdominal pain. This was associated with two episodes of non-bilious vomiting. The patient had passed normal stool on the day prior to admission. On examination, the abdomen was mildly distended but soft and mildly tender throughout. Bowel sounds were present and active. Past surgical history included a laparoscopy and division of a single band adhesion 70cm from the ileocaecal junction 18 months previously. He was referred to the General Surgeons as a case of possible small bowel obstruction with an abnormal “stent” in the small bowel, as seen on the x-ray shown (Fig.1).
Fig.1 Initial X-Ray, (before management)
Question What is the Diagnosis according to Initial X-Ray? a) Small Bowel Stent b) Aortic Graft c) Gastric Stent d) Reading Glasses (see answer on the next page)
Fig.2 Repeat X-Ray, (after management)
- Queen Elizabeth Hospital, Woolwich, SE18 4QH, Stadium Road Greenwich, SE18 4QH, London e-mail: [email protected]
329 A Spectacular Discovery Hellenic Journal of Surgery 2012; 84: 5
Answer Direct questioning showed that the patient had allowed his reading glasses to rest on his abdomen whilst his abdominal x-ray was performed. The patient was discharged home and outpatient clinic follow-up examination did not reveal any problems (Fig. 2).
Key words:
Obstruction, Stent, Reading Glasses
Informed consent has been obtained from the patient.
Conflict of interest The authors declare that they have no conflict of interest.
References 1. Deutsch et al, Small bowel obstruction: a review of 264 cases and suggestions for management, Postgrad Med J. 1989 July; 65(765): 463–467. 2. Singh et al, Understanding diagnostic errors in medicine: a lesson from aviation, Qual Saf Health Care. 2006 Jun;15(3):159-64. 3. Nagle et al, Laparoscopic adhesiolysis for small bowel obstruction, Am J Surg. 2004 Apr;187(4):464-70
81
Data Loading...
