56F Abdominal pain 5 years, ileal perforation 1 year, Lump abdomen 1 month

 A 56 year old female have complaints of pain abdomen since 10 days

History of presenting illness-patient was apparently asymptomatic 6 months ago then she was diagnosed to had intestinal obstruction for which she got operated.Now she has complaints of left iliac fossa pain since 3 months aggregated since 10 days pricking type of pain continuous and associated with fever.

No ho vomiting,diarrhoea 

No h/o blood in urine,Malena ,no h/o headacge,dizziness.

No h/o SOB, palpitations,chest pain.

K/c/o intestinal TB 3 years ago(used ATTmedication for 1year)

K/c/o hypothyroidism 10 years ago on thyronorm 50 MCG 

K/c/o CAD 6 months aho

N/k/c/o hypertension,diabetes,asthma,epilepsy.

Treatment history

Sx laparotomy for iliac perforation.

Personal history:

Diet :Mixed

Appetite : normal

Sleep: adequate 

Bowel and bladder movements: regular

No significant family history


General Examination:

Patient is conscious,coherent and cooperative

Moderately built and nourished

Pallor, icterus, cyanosis , clubbing, Lymphadenopathy -absent

Bilateral pedal edema subsided

Vitals : 

PR : 86 bpm

BP : 110/80 mmHg 

RR : 16CPM

Temperature : 98.6F

Spo2 : 98 % on RA

GRBS-162 mg/dl

Weight:55kg

SYSTEMATIC EXAMINATION

Abdominal examination 

P/A-

Shape.of abdomen-obese

Tenderness- present in left iliac fossa

Palpable mass -No

Hernial.orifices-normal

Free fluid - No

Bruits- No

Liver - Not palpable

Spleen- Not palpable

Bowel.sounds- heard

Cardio vascular system examination 


Jvp not raised 

Inspection:

Shape of chest - elliptical

No visible pulsations

No engorged veins and scars 

Apical impulse not visible


Thrills-no

Cardiac sounds- s1s2 heard

No murmurs

Respiratory Sytem -

Dyspnoea- no

Wheeze- No

Trachea position- central

No adventitious sounds.

CVS 

Level of consciousness-consious 

Speech- normal

No signs of meningeal irritation.


Motor system:

            Rt- UL. LL.           Lt- UL. LL


Bulk - normal N.           N. N 


Tone - N. N.                 N. N


Power - 5/5. 5/5.         5/5. 5/5


Reflexes:         

                       UL            LL


Biceps             . 2+.           2+


Triceps.              2+.         . 2+


Supinator.            2+.         2+


Knee                     2+.        2+


 Ankle.                 2+.           2+


Sensory system: intact

Co ordination is present 

Gait is normal

No Cerebellar signs 

Investigations


24/12/2023

25/122023
After potassium correction








APRIL 2023 CECT SCAN
https://drive.google.com/uc?export=view&id=1cheJPUJxwO78ICMs5gPWo3hcpwgEv4q9https://drive.google.com/uc?export=view&id=1RbnTnn8n-eisfhhnP6qlzn_vIORSq4HG
DECEMBER 2023 CECT SCAN
https://drive.google.com/uc?export=view&id=1WTz3cSy-jv8wX5a0ZnSHCFq9tl4-zJgH




Rectus sheath abscess aspiration


Differential diagnosis
Intestinal tuberculosis
Chrons disease


Provisional diagnosis 

Chrons  disease

 



                   



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