Another ripper ultrasound case this week! I was doing a Sunday – my favourite day! No lab, no Xray department, no Admin folk doing QI stuff etc….. Just straight clinical work. Of course it is tourist season – so the average age of Broome goes up about 30 years!
Elderly chap presented with 24 hours of vomiting. He had had a bit of diarrhea the week prior, but then went on a rough boat ride and developed a tender lump over his umbilicus. Being a stoic fellow he didn’t present until the vomiting was bilious and he was all out of buckets!
On exam he looked pretty crook with a distended belly and a firm, red, warm lump ~ 5 cm above his umbi.
Medical school diagnosis really – SBO secondary to incarcerated umbi hernia. But, here is the trick. This chap had a list of comorbidities a page long, was on another page of meds and was not the sort of person I would usually opt to anaesthetise. Having said that – not a good candidate for a 12 hour plane ride either!
We could demonstrate good venous and arterial flow in all the walls of the entrapped loop.
So – off to theatre and a modest incision, nice healthy bowel returned to the peritoneal cavity and a mesh in. Of course we used the US to do a few TAP blocks at the end of the case – no opiates if we can get away with it.
Over all – a very satisfying case, a happy patient and a lot less stress for all concerned.
I am a GP working in Broome, NW of Western Australia. I work as a hospital DMO (District Med Officer) doing Emergency, Anaesthestics, some Obstetrics and a lot of miscellaneous primary care. Also on the web as @broomedocs | + Casey Parker | Contact