11/11/2023
16 years old boy came through ER with c/o severe abdominal pain and vomiting for one day.
according to patient he was apparently well before this when he suddenly started developing pain around umbilicus which increased in intensity and became severe and 4 epiosdes of vomiting afterwards
On examination patient had a lethargic look but well oriented to time place and person. abdomen was distended but soft and non-tender all over . shifting dullness was negative & on auscultation gut sounds were exaggerated . DRE was insignificant
patients abdominal x rays erect and supine showed multiple air fluid levels and dilated small bowel loops.
ultrasound abdomen showed mild fluid collection. patient was kept on conservative for some time initially by passing NG and foley's catheter , IV fluids and painkillers were started but patient did not respond to that and was decided to operate upon the patient .
Per operatively on opening the peritoneum there was 500 ml of hemorrhagic fluid present which was suctioned, almost 2 feet proximal to ICJ there was outpouching from small intestine(Meckel's diverticulum)which was encircling a portion of small intestine causing strangulation (volvulus). The gut was released around meckel's diverticulum , Meckel's diverticulum was resected along with 6 inches of ileum which looked compromised in vascularity. both the ends of ileum were taken out as stoma.
Today patient was discharged with a functioning stoma and told to come back after a month for reversal.
