doc_clotaire
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Please Explain DOC !
A patient is operated on with the presumptive diagnosis of acute 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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| titly
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E
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| Doc750
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a.
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| Ivonne
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I don't know call the surgeon...
This patient may have and inflammatory disease : Chron or and infection(yersinia)? why don't remove the appendix since we are there " prophylactic appendectomy" because tha patient may develop adherences anyways that can make difficult a future appendectomy. I didn't read any guidelines about this...I am just thinking loud...but I want to learn
Edited by Ivonne on 10/26/07 - 03:58 PM
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| Doc750
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b/c then you can bill twice, duh! 
j/k it's not life threatening, therefore pt has to be given all treatment options, and then consent to the treatment before doing the procedure, and you can't do that while the pt is under.
now if it was the other way around and they went into fix the IBD, but found an inflamed appendix which about to rupture, then you can go ahead and remove it. B/c it's a medical emergency.
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| Kamsi
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B
No indication for removal of any bowel ,appendectomy can as well be done to prevent another laparotomy for it .
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| neuroblastoma
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distance of approximately 30 cm is red , edematous and thickened with creeping of the mesenteric fat onto the ileum
i guess E?
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| Ivonne
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The compromised part is the terminal ileum (30cm out of 4mt) why to worry about the colon? I think the question is about what to do: nothing (close it) or do something...
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| neuroblastoma
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SO,CLOSE IT
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| DrVirgo
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A.
You had consent for an appendectomy ONLY.
The condition you found is not an immediate threat to the patient's life. creeping fat sounds like Chrons -maybe.
All other decisions can be made later after discussing it with the patient.
Close, tell the patient what happened exactly, explain what his options are, and go from there.
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| doc_clotaire
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Answer is : B
From the description , the diagnosis in this question is Acute Regional Enteritis( Crohn 's Disease ) Incidental finding of regional enteritis in patients operated upon for presumed diagnosis of acute apendicitis is medically treated , unless there is proximal obstruction . The risk of operating with regional 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 apendix are not involved , it is advisable to perform appendectomy . In this instance , it would be safe and , if the patient were to have a recurrence in the future , at least ACUTE APPENDICITIS WOULD NO LONGER BE A POSSIBLE DIAGNOSIS and the patient could be treated for an exacerbation of regional enteritis .
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