A women of 35-year old comes to emergency department with symptoms of pain in abdomen and bilious vomitting but no distension of bowel. Abdominal x-ray showed no air fluid level. Diagnosis is :
Correct Answer: Duodenal obstruction
Description: Ans. is 'b' ie Duodenal obstruction Lets see each option one by oneAdynamic ileus or Paralytic ileusis seen commonly after abdominal operations, or post inflammatory conditions of abdomen eg Appendicitis, peritonitis, pancreatitis.Metabolic abnormalities are also a cause.Abdominal distention, usually without the colicky abdominal pain, is the typical & most notable finding.Vomiting may occur but may also be absent.Absent or hypoactive bowel sounds.Multiple air fluid levels on x-ray,Points b & e help in ruling out adynamic ileus.PseudoobstructionThis condition describes an obstruction, usually of the colon in the absence of any mechanical causeThis may occur in acute or chronic form (Acute form is k/a Ogilvie syndrome*) Acute form usually involves only the colon.Vomitting appear late or even absent.Abd. cramps appear late.Abd. distention is the chief symptom.Since it usually involves the colon air fluid level are not seen if the ileo-cecal valve is intact.Points c, d, e help in ruling out Pseudoobstruction in this pt.Ca Rectum :Usually a ds. of old ageObstruction is not a common presentation Even if obstruction occurs, it is insidious in onset with pain & vomiting a late feature. There will be abdominal distention.These point help in ruling Ca Rectum out.Duodenal obstructionFeatures of this pt. match perfectly with duodenal obstruction asPain and vomitting are early features.No distention of bowelNo air fluid level. (There is no distention of bowel and no air fluid level as whole of the intestinal tract distal to the obstruction is patent allowing free passage to gas and the fluids out of body. Obstruction to duodenum prevent further entry of gas or fluids into the intestines).
Category:
Surgery
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