Abdominal Pain and

Swelling
 Demographics
Name: AC
Age: 72
Sex: Male
Occupation: Retired
Address: Arima
Date of Admission: 16/01/17
 History
PC: Painful, Swollen abdomen x 4/7

HPC: 72 yr old male w/ no known prior medical

conditions. Presented to EWMSC on Mon 16/1/17 c/o
painful, swollen abdomen. Patient first noticed
swelling the prev. Friday (13/1) accompanied by lower
abd pain of 1/10 severity in the suprapubic region.
Constant, dull, cramping in nature. No radiation.
Aggravating factors: ? Relieving factors: ? Associated
with constipation and loss of appetite.
 History
Constipation: Normally passes stool 1-2x per
day; change in bowel habit since Oct. 2015 with
constipation and straining to pass stool, relieved
by senna and epsom salts. On this occasion he
had been unable to pass stool since the previous
Friday. 1 flatus, no blood in stool, no mucus in
stool, no hx of light-coloured stool, no pencil
stools. no vomiting, no diarrhea, + loss of
appetite. Claims no history of weight loss.
Pain intensified to 10/10 at night on 15/1. On
morning of 16/1, patient visited Arima DHF. X-ray
 History
ROS
Resp: no cough, no cold, no wheeze
CVS: no chest pain, no Shortness of Breath, no paroxysmal
nocturnal dyspnoea, no orthopnea
GUS: + nocturia every 1-2hrs + frequency, no urgency, +
hesitancy, no poor stream, + dribbling
no blood
GIS: as above
MSK: no muscle pain, no joint pain, no bone pain
CNS: no headache, no dizziness, no weakness, no paraesthesia
 History
Past Medical History: nil
Past Surgical History: nil
Drug History: Senna, Epsom Salts
Family History: unknown
Social History: lives with wife (stroke patient), daughter
and grandchildren.
Smokes: approx. 25 pack years
Alcohol: occasional
Diet: low in red and smoked meats, high in fish and
vegetables
 Examination
Vitals: BP- P- RR- SPO2-

Inspection: Elderly male lying comfortably in bed.

Several tattoos on chest and arms. Cachexic wasting
noted in limbs and chest. Abdomen distended. no
jaundice, no abdominal scars, no caput medusae, no
obvious masses. MM Pink/Dry/AI/AC. NG tube, urethral
catheter and IV on left forearm in-situ.
 Examination
CVS: S1 & S2 were heard, no Murmurs and no Extra
Heart sounds

Resp: Air Entry Equal Bilaterally, no basal crepitation, no

wheeze

Abdominal Exam: Tense, tender in suprapubic region on

deep palpation. No board-like rigidity, no rebound
tenderness, no guarding. no masses, no organomegaly.
 Examination
Abdominal Exam (ctd): Tympanic to percussion. No
shifting dullness or fluid thrill. Increased bowel sounds
heard on auscultation. Bilateral Inguinal herniae (right
side indirect, left side direct) 1 cough impulse 1
reducible no tenderness no erythema no warm to touch

DRE: prostate enlarged, boggy. No stool or blood on

glove
 Investigations

CBC U+E

RBC: 4.86 Na: 132

WBC: 5.9 K: 3.6
HGB:14.0 Cl: 97
HCT: 41.9 Ca: 1.05
PLT: 272 Glu: 113
BUN: 22
Crea: 1.2
 Investigations
CT:
Gross dilatation of caecum, ascending,
descending and sigmoid colon
Short segment of irregular circumferential
bowel wall thickening at sigmoid suggestive
of annular constricting lesion
Prostate is heterogeneous and enlarged in
appearance
 Management
NPO
IV Fluids 3L/24hrs NS/D5W/NS
NG-Tube
Foleys Catheter
Input/Output charting

On day 2 of admission, after CT results were obtained,

patient was consented for Exploratory Laparotomy