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- Title
RAPID DIAGNOSIS AND MANAGEMENT OF ACUTE SURGICAL ABDOMEN PRESENTING WITH NEUROLOGICAL SYMPTOMS: A CASE REPORT.
- Authors
Răchită, Adriana-Anastasia; Modiga, Andrei; Turucz, Emilia
- Abstract
Background: Acute surgical abdomen poses a diagnostic challenge, especially when neurological symptoms precede abdominal manifestations. Timely recognition and management are critical for optimizing patient outcomes. Objective: This study emphasizes the importance of rapid and accurate differential diagnosis, appropriate laboratory investigations, and swift intervention in patients with neurological symptoms, ultimately leading to the diagnosis of acute surgical abdomen. Material and methods: We present the case of a 21 years old patient who presented to the Emergency Department with altered mental status, abdominal discomfort, diarrhoea and subsequent right-sided lower limb motor and sensory deficit, starting 3 days prior to presentation. At presentation BP was 65/30 mmHg, HR 130 bpm, SpO2 86% in room air, Capilary Refill Time 5 seconds, pale, sweaty skin, generalized skin marbling and altered mental status. Initial management consisted of fluid resuscitation, high-flow O2 via face-mask, vasopressor support, broad spectrum empiric antibiotherapy and supportive treatment. Despite the initial consideration of a neurological cause and a negative cerebral CT scan, after a thorough physical examination, a native abdominal CT scan was performed, revealing gangrenous appendicitis with necrosis and ischemia in the right iliac fossa, marked muscular and perimuscular air infiltration of the iliopsoas muscle and cecal necrosis, while an abdominal contrast enhanced CT scan identified a retroperitoneal abcess and compression of the right external iliac artery. Blood work revealed severe leukopenia, neutropenia, severe metabolic acidosis, and hypoglycemia, while inflammatory tests and sepsis markers were elevated. The final diagnosis was toxic shock, acute surgical abdomen through perforated appendicitis, retroperitoneal abscess, compartment syndrome of the right thigh, and severe metabolic acidosis. The multidisciplinary team of emergency physicians and surgeons decided to transport the patient for emergency surgery. The patient's intraoperative and postoperative outcomes were dismal, and she died two days later. Results : Prompt and thorough examination is crucial for patients with neurological symptoms of an acute surgical abdomen to obtain positive outcomes. To provide effective patient management, a multidisciplinary team must make meticulous decisions, as well as extensive perioperative preparation, due to the case's complexity. Furthermore, the interval between symptom start and presentation at the emergency room is critical to the patient's outcome. Conclusions: In emergency setting, the initial symptoms can mislead the emergency physician, physical examination being of great importance. Despite the fact that rapid evaluation, management, investigation and appropriate laboratory tests facilitated the diagnosis, the severity of the disease lead to unfavorable outcome for the patient.
- Subjects
ROMANIA; DIARRHEA; ABDOMINAL pain; CONFERENCES &; conventions; ACUTE abdomen; NEUROLOGICAL disorders; TOXIC shock syndrome
- Publication
Acta Marisiensis. Seria Medica, 2024, Vol 70, p37
- ISSN
2668-7755
- Publication type
Article