Case presentation (NO. 7) (sent to inbox of Tele-Surgical Masrawy) Female patient aged 42y presented with the classic manifestations of appendicitis 3 days before , The patient was diabetic , suffered from rheumatoid arthritis with history alternating diarrhea and constipation in the previous 8 month Then appendectomy was done where there were suppurative appendicitis associated with telephitis , the base of the appendix was severely inflamed that the surgeon ligated it with doubt about it and he put a drain 3 days postoperative , drain strated fecal discharge of ~250 cc that increase in amount to be between 300-400 cc /d in the next 4days with the leak came from drain and from around it , there was no fever , patient passed flatus with little stool once /day surgeon asks : * what the plan in such case ? To interfere surgically or conserve * If conservative ; What the parameters to follow and investigations to do? Allow oral or TPN If TPN How he can do it ,( where the hospital has no nutritional or ICU specialist , there is no experience in TPN If oral feeding which type of food ? When he interfere surgically ? * If surgical interference is recommended , rt hemicolectomy will recommended or other procedure ? * Surgeon ask about the base of the appendix in such case , if there is any approach to do ? or defects , he did in the case
Posted on: Wed, 29 Oct 2014 20:16:48 +0000
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