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Delay in diagnosis of intestinal obstruction in a patient with familial mediterranean Fever.

Kaya B, Eriş C, Uçtum Y - Clin Med Insights Case Rep (2010)

Bottom Line: Familial Mediterranean Fever (FMF) is a recurrent disease characterized by inflammatory process effecting synovial membranes such as peritoneum, pericardium and joints.He was operated on after 10 days of symptoms.Delay in diagnosis and treatment of the case discussed with literature review.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Faith Sultan Mehmet Training and Research Hospital, Istanbul, Turkey.

ABSTRACT
Familial Mediterranean Fever (FMF) is a recurrent disease characterized by inflammatory process effecting synovial membranes such as peritoneum, pericardium and joints. It usually presents with acute abdominal pain. Intestinal obstruction secondary to adhesions may be observed in FMF patients. Sometimes diagnosing intestinal obstruction can be a challenging problem. We were presented a patient with FMF and adhesive intestinal obstruction. He was operated on after 10 days of symptoms. Delay in diagnosis and treatment of the case discussed with literature review.

No MeSH data available.


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Adhesion, causing bowel obstruction in exploration.
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f2-ccrep-2010-059: Adhesion, causing bowel obstruction in exploration.

Mentions: Twenty-four year old Turkish man, presented with history of nausea, vomiting and weight loss in the last ten days. His medical history was remarkable only in the diagnosis of FMF. He had been diagnosed as FMF without any genetic testing, only clinical findings. He was receiving colchicine treatment. He had been followed-up as an acute FMF attack in a different hospital before admission to our clinic. On physical examination, he was pale and lean in appearance. The arterial blood pressure was 100/60 mm-Hg with the pulse rate of 78/minute-rithmic. The abdominal examination revealed minimally distended abdomen with tenderness in all quadrants. There were no rebound tenderness and defence in abdominal palpation. Bowel sounds were hipoactive. The rectum was empty in rectal examination. Laboratory results were as follows: White blood cell count: 12,200/mm3 (2000–10,000 mm3), CRP: 138.2 mg/dl (0–5 mg/dl), ESR: 23 mm (1 hour), 52 mm (2 hour). Other laboratory tests including glucose, urea, creatine and electrolytes were normal. There was a small bowel air-fluid level in abdominal x-ray on right side (Fig. 1). Dilated intestinal loops were detected in abdominal ultrasonography. The patient was hospitalized. He was given intravenous fluids (Isotonic 1000 cc and Isolyte 1000 cc solutions) before operation. He underwent laparotomy. On exploration, jejenal loops were found dilated. There were intrabdominal adhesions in between liver and peritoneum. There was an adhesion formation in small intestine causing total intestinal obstruction about 70–75 cm distal to the Treitz ligament (Fig. 2). The small intestine and mesentery were normal without any ischemia or necrosis. The bridectomy was performed. Parenteral nutrition with Kabiven Peripheral infusion emulsion (3.7 ml/kg/hour) was started postoperatively. Paralytic ileus that has been developed after surgery was treated with mobilization, restricting oral intake and fluid resuscitation. Then the patient was discharged uneventfully.


Delay in diagnosis of intestinal obstruction in a patient with familial mediterranean Fever.

Kaya B, Eriş C, Uçtum Y - Clin Med Insights Case Rep (2010)

Adhesion, causing bowel obstruction in exploration.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3046008&req=5

f2-ccrep-2010-059: Adhesion, causing bowel obstruction in exploration.
Mentions: Twenty-four year old Turkish man, presented with history of nausea, vomiting and weight loss in the last ten days. His medical history was remarkable only in the diagnosis of FMF. He had been diagnosed as FMF without any genetic testing, only clinical findings. He was receiving colchicine treatment. He had been followed-up as an acute FMF attack in a different hospital before admission to our clinic. On physical examination, he was pale and lean in appearance. The arterial blood pressure was 100/60 mm-Hg with the pulse rate of 78/minute-rithmic. The abdominal examination revealed minimally distended abdomen with tenderness in all quadrants. There were no rebound tenderness and defence in abdominal palpation. Bowel sounds were hipoactive. The rectum was empty in rectal examination. Laboratory results were as follows: White blood cell count: 12,200/mm3 (2000–10,000 mm3), CRP: 138.2 mg/dl (0–5 mg/dl), ESR: 23 mm (1 hour), 52 mm (2 hour). Other laboratory tests including glucose, urea, creatine and electrolytes were normal. There was a small bowel air-fluid level in abdominal x-ray on right side (Fig. 1). Dilated intestinal loops were detected in abdominal ultrasonography. The patient was hospitalized. He was given intravenous fluids (Isotonic 1000 cc and Isolyte 1000 cc solutions) before operation. He underwent laparotomy. On exploration, jejenal loops were found dilated. There were intrabdominal adhesions in between liver and peritoneum. There was an adhesion formation in small intestine causing total intestinal obstruction about 70–75 cm distal to the Treitz ligament (Fig. 2). The small intestine and mesentery were normal without any ischemia or necrosis. The bridectomy was performed. Parenteral nutrition with Kabiven Peripheral infusion emulsion (3.7 ml/kg/hour) was started postoperatively. Paralytic ileus that has been developed after surgery was treated with mobilization, restricting oral intake and fluid resuscitation. Then the patient was discharged uneventfully.

Bottom Line: Familial Mediterranean Fever (FMF) is a recurrent disease characterized by inflammatory process effecting synovial membranes such as peritoneum, pericardium and joints.He was operated on after 10 days of symptoms.Delay in diagnosis and treatment of the case discussed with literature review.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Faith Sultan Mehmet Training and Research Hospital, Istanbul, Turkey.

ABSTRACT
Familial Mediterranean Fever (FMF) is a recurrent disease characterized by inflammatory process effecting synovial membranes such as peritoneum, pericardium and joints. It usually presents with acute abdominal pain. Intestinal obstruction secondary to adhesions may be observed in FMF patients. Sometimes diagnosing intestinal obstruction can be a challenging problem. We were presented a patient with FMF and adhesive intestinal obstruction. He was operated on after 10 days of symptoms. Delay in diagnosis and treatment of the case discussed with literature review.

No MeSH data available.


Related in: MedlinePlus