B98401002

09A 16-2 3419980

Chief complaint: Progressive abdominal cramping pain with severe diarrhea (about
once per hour) since 12/2
Brief history: This is a 67-year-old man who had acute suppurative appendicitis, s/p
laparoscopic appendectomy on 2014/11/27. Operative Findings:
(1) Acute appendicitis (erythematous, suppurative, gangrenous)
(2) Ascites(+), turbid about 250ml
(3) Fecolith(-)
(4) Perforation(+)
Under stable condition, he was discharged with oral Ceflour. Mild abdominal dull pain
over LLQ was noted after surgery, which was almost relieved by defecation. Because
of progressive abdominal cramping pain with severe diarrhea (about once per hour)
since 12/2, he was brought to our ED for help, where lab data revealed leukocytosis
(WBC: 14.90k, Seg: 86.3), PE showed tenderness over middle portion, abdominal CT
disclosed postoperative changes, RLQ abdomen with localized ileus, r/o
inflammatory/infectious process with possible abscess formation;
inflammatory/infectious process, sigmoid colon, r/o peritonitis. Ascites culture (11/28)
showed ESBL. Due to intra-abdominal infection suspicious of previous appendix
perforation related, he was transferred to 9A ward for further treatment.
Discussion:
The patient showed mild fever in the hospital. After antibiotics treatment, the fever
subsided gradually, and the abdominal pain also improved. The patient received
abdominal echo examination on 12/11, which showed no lobulated mass at RLQ. We
shifted the antibiotics to oral form since 12/12 and followed the LAB data on 12/14
morning with no critical findings. Due to stable vital sign and no general abnormality
finding, the patient was discharge on 12/15.
The reason why I was late for the professor round is because I was reviewing articles
for the previous days case discussion until late in the midnight and I overslept on the
following day. I am sorry for my behavior and wish to learn directly from the
professors surgical performance in the future.