Posted by HFHSM.D.-yz on February 04, 1998 at 14:14:19:

In Reply to: Young lady with unresolving tachycardia and other complicatins after intestinal obstruction surgery posted by Shailendra on January 28, 1998 at 09:18:40:

: To all,
A 24 year old woman came to the hospital emergency room with
abdominal distension. She had been admitted earlier to another hospital
where she complained of vomiting, diarrohea,for 3 days. She was treated
with loperamide and domperidone. She later started developing abdominal
distension. After tapping the fluid, distension again started. The
fluid was normal in fluid contents. Admitted on Sunday to our hospital.
Emergency operation was done to relive obstruction. The cause of
obstruction was omental piece winding around the distal ilieum. Post-op
period initially was ok except fof tachycardia. However tachycardia
persisted and Spo2 started decreasing and she has to be put on ventilator.
BP was 120 systolic but diastolic hard to measure but around 80.

RR-45/min
pulse feeble
cvp- 2 cm of H2O later came upto 7-9 cmof H2O
Little or no Abdominal distension.

Digitalization started but Heart rate still 140/min
T3 and T4 levels normal.
ELectrolytes normal except slight hypokalemia.

Lady was pregnant and delivered healthy baby 6 months back
She comes from middle class family.

Other info upon request. Please e-mail.

Thanking you,
Shailendra

Dear Shailendra,

After reading your description of the patient’s clinical condition I am inclined to think that you have had some experience in dealing with patients or have undergone medical training.
Your patient developed acute abdominal distention after being treated with domperidone and loperamide. This makes sense since she was treated with medications that are relatively contraindicated in acute intestinal obstruction. On the other hand, from your description it remains unclear to me whether her abdominal distention was secondary to air or fluid collecting in the abdomen. Ascites or fluid collecting in the abdomen is often tapped. If a tap or paracentesis is performed the fluid is often tested and these tests are often helpful in making a diagnosis. If she had ileus with air filled loops of bowel, a tap would be an unusual procedure.
The cause of the underlying intestinal obstruction is also unclear. Did she have prior surgery and scar tissue in her abdomen (adhesions) or did she have a structural or congenital lesion responsible for the blockage?
The differential diagnosis of post-operative tachycardia is extensive. It would be important to review the electrocardiographic tracings so that the specific cardiac rhythm could be determined. It is necessary to exclude causes such as a pulmonary embolus (clot to the lung), an infectious process (sepsis) , an underlying cardiac disorder such as congestive heart failure, an electrolyte disturbance, post-operative pain and a medication effect.
I hope that your patient’s condition improves and that she can be weaned off the ventilator. Good luck in caring for your patient.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.

HFHSM.D.-yz
keywords: bowel obstruction; ileus
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