2 Case report
A 21 year old young Ethiopian man presented with abdominal cramps,
bilious vomiting, and abdominal distention of 48 hours duration to
Zewditu Memorial Hospital, Addis Ababa, Ethiopia. He had no history of
similar illness before and there were no history of prior surgery.
At presentation he was acutely sick looking with feeble pulses and a
blood pressure of 60/40 mm of mercury. Abdomen was moderately distended
with direct and rebound tenderness all over and absent bowel sounds.
Rectum was empty on per rectal examination.
Investigations revealed white cell count of 18,000, hemoglobin of
15.49gm/dl and his blood group is AB positive. Erect abdominal x-ray
showed multiple air fluid level and distended bowel loops suggestive of
small bowel obstruction (figure 1).
Aggressive resuscitation with crystalloids started and his blood
pressure recovered to 100/60mm of mercury and his pulse become well
palpable and he produced adequate urine. He was then explored through a
long midline incision.
Laparotomy showed a very mobile cecum and ascending colon(not attached
to posterior abdominal wall) and the proximal ileum and jejunum was
wrapped around the base cecum as well as ascending colon. Most of
jejunum, whole of ileum and most of ascending colon were gangrenous. The
knot were unwrapped and the gangrenous intestine packed with warm saline
for 10 to 15 minutes (figure 2). We were able to salvage only 40 cm of
jejunum and the rest were resected. The remaining jejunum was
anastomosed with transverse colon and abdomen closed.
He was kept in an intensive care for three days. Later he developed
frequent diarrhea of ten to fifteen times a day. This was managed with
fluid replacement, anti-motility drugs, and proton pump inhibitors and
after the 10th day parenteral nutrition. The diarrhea
decreased gradually and he was discharged home after 20 days of hospital
stay.