Wednesday, November 16, 2011

Acute Abdomen . . . Unusual cause

The acute abdomen is has always been a favorite question with examiners in under-graduate and post-graduate examinations.

Just wanted to share one of our patients, RD, pregnant for about 8 months who came in with severe abdominal pain. She had already been in couple of places where a diagnosis of preterm labour and was made and she was started on all sorts of medications to stop uterine contractions.

We had already been burdened with quite a number of patients which has stayed put since the Golden Jubilee. RD came in sometime between SD's and PD's arrival in hospital.

I just could not make heads or tails of the diagnosis as the patient appeared to be writhing in pain, but had a very soft abdomen and the uterus was far from any sort of contractions. So, I asked Nandu to take a relook at RD. Nandu was also quite baffled. But he had picked up some chest findings and he asked me to look at the possibility of a pneumonia.

Yes, it was pneumonia. There was an area of bronchial breathing with fine crepitations in the left basal region. And the X-Ray chest confirmed it. In addition, she had a total count of 28500 with predominantly neutrophilia with toxic changes.  

RD responded quite well to antibiotics. As quite commonly seen in antenatals in this part of the world, she was also anemic and after we did a blood transfusion, RD's road to recovery was quite fast.

We thank God that RD reminded us to go through our text-books once in a while so that our grey cells remain active and refreshed.

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