19/F EPTB

 19 FEMALE STUDENT BY OCCUPATION  CAME TO GENERAL SURGERY OPD WITH COMPLAINTS OF PAIN IN LOWER ABDOMEN SINCE 3MONTHS 

HOPI:

PATIENT WAS APPARANTELY ASYMPTOMATIC 3MONTHS BACK THEN SHE NOTICED PAIN IN UPPER ABDOMEN,SQUEEZING TYPE OF PAIN,INTERMITTENT AND RELIEVED ON DEFECATION AND NO AGGRAVATING FACTORS. PAI IS CONTINUOUS SINCE 10DAYS AND PAIN RELIEVED ON DEFECATION AT MORNING. H/O FEVER ASSOCIATED WITH CHILLS AND RIGOR AND MORE AT EVENING AND RELIEVED AFTER MEDICATION H/O CONSTIPATION SINCE 3MONTHS H/O VOMITINGS AND LOOSE MOTIONS 1MONTH BACK H/O OLIGOMENORRHEA SINCE 6MONTHS H/O WEIGHT LOSS 10KG OVER 6MONTHS NO H/O BURNING MICTURITION NO H/O NAUSEA NO H/O LOSS OF APPETITE 

N/K/C/O HTN,DM,ASTHMA,CVA,CAD 

NO PAST SURGICAL HISTORY

FAMILY H/O FATHER WAS DIAGNOSED WITH TB IN 1995 AND 2007 AND TOOK ANTI TUBERCULOSIS TREATMENT

 ON EXAMINATION

 PT IS C/C/C BP-90/60 MMHG PR-80BPM RR-17CPM TEMP-AFEBRILE SPO2-99% ON ROOM AIR

L/E ON INSPECTIONABDOMEN IS SCAPHOID UMBILICUS-CENTRAL AND INVERTED ALL QUADRANTS MOVING ACCORDINGLY WITH RESPIRATION NO SCARS,SINUSES NO ENGORGED VEINS NO VISIBLE PERISTALSIS NO VISIBLE PULSATIONS PALPATIONTENDERNESS+ IN RIGHT ILEAC FOSSA ALL INSPECTORY FINDINGS CONFIRMED VAGUE MASS PALPABLE IN RIGHT ILIAC FOSSA NO ORGANOMEGALY NO PALPABLE PULSATIONS AUSCULTATIONBS+

 SYSTEMIC EXAMINATION 

CVS-S1,S2+

 RS-BAE+

 CNS-NAD 

MANTOUX TEST WAS DONE ON 21/07/2023 INTERPRETATION - POSITIVE 

PULMONOLOGY REFERRAL WAS DONE ON 26/07/2023 FOR STARTING OF ANTI TUBERCULOSIS TREATMENT ADVICED 1)START ATT UNDER NTEP/DOTS 2PILLS/DAY/BBF 2)TAB. BENADONE 40MG PO/OD 3)IRON RICH DIET 

Investigation USG ABDOMEN AND PELVIS(19/07/2023) FINDINGS1)E/O BOWEL WALL EDEMA WITH WALL THICKENING NOTED IN TERMINAL ILEUM(4- 5MM),CAECUM AND ASCENDING COLON(7-8MM) WITH INCREASED VASCULARITY AND SURROUNDING INFLAMMATORY CHANGES IN OMENTUM AND ENLARGED MESENTRIC LYMPH NODES (M) 6MM. 2)A PORTION OF THE TERMINAL ILEUM IS SEEN PROLAPSING INTO THE CAECUM AND ASCENDING COLON FOR A LENGTH OF ICM 3)NO BOWEL WALL ISCHEMIA IMPRESSION1)F/S/O TERMINAL ILEOCOLITIS/TYPHILITIS WITH MESENTRIC LYMPHADENOPATHY WITH PARTIAL/TRANSIENT ILEOCOLIC INTUSSUSCEPTION 

CHEST XRAY PA VIEW(OVER INFLATION)-(21/07/2023) THE LUNGS ON EITHER SIDE SHOW EQUAL TRANSLUCENCY THE PERIPHERAL PULMONARY VASCULATURE IS NORMAL NO FOCAL LUNG LESION IS SEEN THE PLEURAL SPACES ARE NORMAL BOTH HILA ARE NORMAL IN SIZE,HAVE EQUAL DENSITY AND NO MEDISTINAL ABNORMALITY THE CARDIAC SIZE IS NORMAL THE DOMES OF DIAPHGRAMS ARE NORMAL IN POSITION 

IMPRESSIONNO E/O PULMONARY,PLEURAL OR CARDIAC PATHOLOGY XRAY ERECT ABDOMEN(20/07/2023) THERE IS NO GAS UNDER DIAPHRAGM NO AIR FLUID LEVELS NO ABNORMAL SOFT SHADOW/CALCIFICATION NO RADIO OPAQUE CALCULUS IS SEEN IMPRESSIONNO E/O ANY BOWEL OBSTRUCTION OR FREE INTRA PERITONEAL GAS IS NOTED 

CECT SCAN-ABDOMEN(20/07/2023) IMPRESSIONDIFFUSE,LONG SEGMENT,CIRCUMFERENTIAL WALL THICKENING OF ASCENDING COLON,CAECUMAND TERMINAL ILEUM SURROUNDING FAT STRANDING AND MULTIPLE ENLARGED MESENTERIC,PARACOLIC,PRE AND PARA AORTIC LUMPH NODES WITH NECROTIC NODES. 

CULTURE AND SENSITIVITY OF PERITONEAL FLUID(24/07/2023) FEW DISINTEGRATED PUS CELLS, OCCASIONAL GRAM NEGATIVE BACILLI SEEN E.COLI GROWN. SENSITIVE TO ALL ANTIBIOTICS PEITONEAL FLUID ADA(24/07/2023)---18U/L CBNAAT(25/04/2023)-NEGATIVE 

REVIEW USG ABDOMEN AND PELVIS(29/07/2023) IMPRESSIONILEOCAECAL THICKENING NOTED SUBUMBILICAL LYMPH NODES NOTED IN MESENTRY MINIMAL ASCITES 

Treatment Given

OT NOTES

PT WAS DIAGNOSED WITH ? ILEOCAECAL TB SURGERY WAS DONE ON 24/07/2023 SURGERY EXECUTED -DIAGNOSTIC LAPAROSCOPY+OMENTUM AND LYMPH NODE BIOPSY UNDER GA OPERATIVE FINDINGS3TO4 TUNERCLES O SIZE AROUND 1X1CM PRESENT OVER TERMINAL ILEUM AND CAECUM OPERATIVE PROCEDUREUNDER STRICT ASEPTIC CONDITIONS,GENERAL ANAESTHESIA,PARTS PAINTED AND DRAPED.10MM SKIN INCISION WAS GIVEN AT THE UMBILICUS. VERESS NEEDLE WAS INSERTED,PNEUMOPERITONEUM CREATED.UNDER VISION 2 5MM PORTS WERE PLACED AT LEFT AND RIGHT ILIAC FOSSA. BOWEL WAS INSPECTED FOR ANY STRICTURES. 3TO4 TUBERCLES OF SIZE 1X1CM PRESENT AT TERMINAL ILEUM AND CAECUM. OMENTUM WAS ADHERED TO CAECUM. OMENTAL BIOPSY WAS TAKEN, PERITONEAL FLUID WAS COLLECTED AND BIOPSY SENT FOR HPE. PERITONEAL FLUID FOR CBNAAT, ADA AND CULTURE SENSITIVITY. SKIN INCISION CLOSED. PROCEDURE WAS UNEVENTFUL

 POSTOPERATIVE TREATMENT 1)NBM TILL FURTHER ORDERS

 2)IVF-2PINT 5D, 1PINT NS, 1PINT RL @75ML/HR

 3)INJ.PAN 40MG IV/OD

 4)INJ.PCM 1GM IV/BD

 5)INJ.CIFRAN 500MG IV/BD 

6)INJ.METROGYL 100ML IV/TID 

7)MONITOR VITALS

 1)HIGH PROPTEIN DIET---3TO4 EGG WHITES/DAY 

2)INJ.CIFRAN 500MG/IV/BD

 3)INJ.METROGYL 500MG/IV/BD 

4)TAB.PAN 40MG PO/OD 

5)TAB.PCM 650MG PO/TID 

6)TAB.CHYMORAL FORTE PO/TID

 7)TAB.MVT PO/OD

 8)TAB.ATT(NTEP/DOTS) 2TABS/DAY

 9)TAB.VIT C PO/OD 

10)TAB.BENADON 40MG PO/OD 

11)INJ.ASTYMINE FORTE IV/BD 

12)TAB.B-COMPLEX PO/OD 

13)2 TBSP PROTEIN POWDER IN 1 GLASS OF WATER/ MILK PO/BD

 14)ACTIVE AMBULATION