doc_clotaire
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Please Explain !
A patient is operated on with the presumptive diagnosis of actute apendicitis . However at the operative , the apendix and cecum are found to be normal . Terminal ileum for a distance of approximately 30 cm is red , edematous and thickened with creeping of the mesenteric fat onto the ileum . There is no dilation of the bowel proximal to the area of involvement . The remainder of the small bowel . What is the next step in the management ?
a ) Closure of the abdomen
b ) appendectomy
c ) ileostomy proximal to the area of involmement
d ) side to side ileo transverse colostomy
e ) right hemicolectomy
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| DrVirgo
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Involvement of the Ileum and Creeping Fat sounds like Chrons.
No dilation proximal to the area of involvement, so i guess there is no obstruction so this is not really an emergency.
So I would say A... Close the abdomen...
IF patient has Chrons, it can be managed medically...
He was operated on with the presumptive diagnosis of acute appendicitis, thinking he would get an appy. If the diagnosis is something else, he needs to consent to that surgery or treatment FIRST. Since this is non-emergent, close the abdomen and tell the patient what was found and discuss any future tests, or other thoughts on diagnosis and treatment later.
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| nadiabarati
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agree with Drvirgo
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| chemamr
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agree
are we right?
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| doc_clotaire
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Like Fisher would say :
A is the most common wrong answer that the boards are looking for .
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| young_doc
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you're not about to open up the abdomen and NOT take the appendix out!!!
B is the answer.
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| young_doc
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(btw same question is in discussion on the surgery forum)
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| DrVirgo
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So removal of the appendix is indicated in Chrons disease even if there is nothing wrong with it (prophylactic appendectomy?) ??
So B is the right answer???
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| webjeee
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right, remove it, it depends on the cecum.
in crohn, if ceum is inflammatory about to perforate, you can't simply remove the appendix. It is rule i see somewhere.
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| doc_clotaire
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Answer is : B
From , the description , the diagnostic in this patient acute regional enteritis ( Crohn 's Disease ) Incidental finding of regional enteritis in patients operated upon for the presumed diagnostic of acute appendicitis is medically treated , unless there is proximal obstruction . The risk of operating on patient with regional enteritis is formation of fistula and abcess , especially if the area to be resected is involved with the disease process . However , if the cecum and the apendix are not involved , it 's advisable to perform appendectomy . In this instance , it would be safe and , if the patient were to have recurrence in the future , AT LEAST , ACUTE APPENDICITIS WOULD NO LONGER BE A POSSIBLE DIAGNOSTIC and the patient could be treated for an exacerbation of regional enteritis .
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| DrVirgo
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Thanks, good explanation. 
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