Authors: Shabnam Islam, Kim Goddard.
A 63-year-old female presented with a seven day history of generalised abdominal cramp associated with vomiting and diarrhea. On abdominal examination there was no focal or generalised peritonism. On admission her white cell count was 16 and CRP was 8. Patient became hypotensive on admission and was transferred to Intensive care unit for vasopressor support. The follow-up assessment revealed patient’s abdominal pain to be improving with mild tenderness on right upper quadrant. But, patient’s inflammatory marker deteriorated to 382. The decision was taken for diagnostic laparoscopy which showed four quadrant pus with closed bowel perforation at the site of jejunal diverticulitis on the mesenteric border. A bowel resection was not performed given the closed defect. Patient was given diligent washout. Recovery was uneventful, and patient was discharged home only to return three days later with Peritonitic abdomen requiring urgent laparotomy and bowel resection which had further complications which led to Intensive care unit admission and wound infection.
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