Presentation
Increasing abdominal pain over 3 days. Bowels not opened for 2 days.
Patient Data
Age: 75 years
Gender: Male
From the case:
Ischemic bowel due to internal hernia with perforation
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A large amount of intra-abdominal free fluid and gas indicates a perforated hollow viscus. The majority of the free gas is in the upper right side of the abdomen.
Case Discussion
The patient proceeded to theater immediately for laparotomy.
Operative findings
- internal hernia with frankly ischemic distal ileum
- several omental bands
- haemopurulent fluid in all 4 quadrants
Procedure
- omental band adhesions identified and divided
- internal hernia reduced
- approximately 30cm of distal ileum ischemic and gangrenous
- ileum divided proximal and distal to area of demarcation using 80GIA
- copious saline wash
- abcarian ileostomy formed
- drain left in pelvis and right paracolic gutter
- PDS closures and staples to skin
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