ACUTE ABDOMENBY: IBRAHIM AL-QATTAN

DEFINITION:• Sudden

• Spontaneous

• Non-traumatic

• Urgent surgical intervention may be required.

CASES 1: Mohammed is a 45 yr old gentleman, smoker (50 pack yr),

with history of MI and DM, presented to the emergency room with abdominal pain of 20 mins duration. Pain was generalized, sudden in onset, not localized, continuous and increasing with time, and was precipitated by his last meal that he ate 25 min before the presentation. The pain was so severe that brought him to the hospital straight away.

Pain was associated with bloody stool. Pt also reported loss of weight (70 to 50 kg) in the last 6 months

because he doesn’t eat because of fear from pain after eating. There was Hx of previous attack but it was much less severe. No previous Hx of DVT or hypercoagulability.

On examination: Pt looked ill, Bp: 110/60, HR, 110, RR 30, temp: 37.7. Abdominal examination showed a mildly distended abdomen, and

mild tenderness, otherwise everything was normal.

What is your diagnosis?

Acute mesenteric ischemia.

What is the next step? Admission and resuscitation. Insertion of Foley's catheter. IV anti-biotics.

If the pt had signs of peritonitis, what would you do? Urgent laparotomy.

If signs of peritonism were negative, what would you do?

CT-angio.. Why?

Other radiologic studies? Plain abdominal X-ray. Dopplex US CT-scan MRI MRA

Treatment

If Peritonism is absent: TOC is surgical embolectomy.

Managed nonoperatively with repeated angiograms.

If AMI was due to a large thrombus or emobolus papaverine.

Pt with peritoneal signs laparotomy.

CASE 2: Ahmed is a 65 yr old gentleman, smoker, diabetic,

hypertensive, with previous Hx of TIA, presented to the ER complaining of abdominal pain of 1 hr duration. Pain began in the center of the abdomen, sudden in onset, tearing in nature, radiates to the back, continuous, no aggravating or realieving factors, pt gave the pain 10/10 on severity scale.

This is the first time for this presentation. Pt’s father died from a ruptured aortic aneurysm.

On examination: Pt looked ill, was in severe pain. Pulse:120 BP 110/70 RR 24 On abdominal examination: Abdomen was flat with central pulsating mass. Palpation revieled mild diffuse tenderness, an expansile

pulsatile mass in the center if the abdomen with clear upper and lower borders.

Dimished bowel sounds.

What is your diagnosis? AAA

THANK YOU!