Question

“A hospital emergency room received a 23-year-old male with complaints of severe diarrhea, abdominal cramping, nausea, and “just not feeling too good.” He reported that similar symptoms had been present for the past ten days, but the intensity of the current bout of symptoms had frightened him and he felt the ER was a better choice than his regular doctor.

​His history revealed no significant previous illness except for a similar, milder GI attack six months prior, as well as periodic episodes of mild diarrhea, which he diagnosed as “allergies to all the stuff they put in food these days,” but for which he’d sought no medical help. His temperature was mildly elevated (37.9o), he had a slight tachycardia, and his blood pressure was normal. His right lower quadrant was tender on palpation, and rebound tenderness was present. Bowel sounds were normal. Blood tests indicated a reduced hemoglobin of 11 g/dl and an increased WBC count.

​The young man was admitted with a possible diagnosis of acute appendicitis. A general surgeon agreed with the diagnosis and the patient was scheduled for surgery.

​During the operation the appendix appeared only mildly hyperaemic and no other abnormalities were noted, except for some mild swelling in a few mesenteric lymph nodes. A routine appendectomy was performed, and the patient’s recovery was uneventful. Subsequent microscopic study revealed the appendix to have been normal. The patient was discharged after three days.

​After six weeks he reported to his GP that his symptoms had returned after going back to his normal solid food diet. He also complained of feeling fatigued and reported weight loss since the operation. He was examined and found to be tender in the lower right quadrant as before. A rectal examination revealed additional sensitivity, and blood was noted in the stool.

​Blood tests showed WBC counts increased and Hb decreased (9 g/dl) with respect to their previous levels. Urinalysis and blood tests were normal, and blood and urine cultures for bacteria and parasites were negative. A lower GI radiographic study revealed a normal ileal lumen except for a 6-cm segment that demonstrated pronounced stenosis. Endoscopic study of the ileum by a gastroenterologist confirmed the diagnosis.”

Source of case study – TBA at another time

1) What is the likely diagnosis for this patient? Give reasons for your answer.

2) What treatment would likely be prescribed at the present time?

3) What treatment might be considered if the patient experiences several recurrences over the next   

  two years, if most required hospitalization and total parenteral nutrition (TPN) to rest the bowel?

Answer 1

1 The diagnosis for the disease seen in the 23 year old male is ilieal stenosis.Tenderness in the lower right quadrant suggests that it is related to intestine. Nausea, diarrhoea, abdominal cramps since 10 years suggest it to be an structural defect rather than something present in food.

2.The primary treatment include anti -inflammatory drugs.This will reduce pain due to inflammation.

3.In several recurrences , the treatment includes the removing the stenosis segment of intestine and suturing the bowel together ,thereby increasing continuity of intestine.