Acute Increasing Pain in Tenderness in Upper Abdomen
The patient male, 45 years old was referred to ER with acute increasing pain in abdomen and tenderness in upper abdomen. In review of his medical history he had 5 time abdominal operation about 8 years ago in his country for morbid obesity and complication emerged post operation. As the presenting clinical picture of current condition was suggesting an acute abdomen process with impression of Acute Cholecystitis. The imaging studies were not helpful as there was lots of adhesion and deformities in internal abdominal organs due to previous complications and surgeries. The patient was planned for laparoscopic surgery. As laparoscope was introduced to abdominal cavity there was too many adhesions and deformities which could endanger vital organs and complicate surgeries process, with proper planning and meticulous search the Gall Bladder area was opened up and a complicated Cholecystitis and perforated gall bladder found out. As the complexity of region anatomy and possibility of damage to adjacent transverse colon surgery was converted to open and cholecystectomy was done and as transverse colon perforation in two spots revealed repair completed. In few days after first surgery a fistula between transverse colon and abdominal wall mesh was developed which presented by fecal discharges from the abdominal anterior wall accompanied by pain and patient discomfort. With regard to patient condition second operation was planned and transverse colon colectomy and repair of abdominal wall completed. After second surgery patient had a rapid improvement course without any further complication. Patient gained proper weight, general condition and patient activity and performance returned to normal level for him as before surgeries. In such complicated cases there is high risk for developing different kind of Fistulas which different approaches considering type of Fistula and patient’s circumstances could be considered. In our patient as the Fistula was to the previous foreign body (Abdominal Wall Mesh) its autonomous closure was not probable; so immediate surgery needed to provide better course of life for the patient.
Sunday, January 28, 2018 - 08:00