Comprehensive Management of Recurrent Ascites Following Right Hemicolectomy for Abdominal TB
PACE Hospitals’ Surgical Gastroenterology team successfully performed a Exploratory Laparotomy with Adhesiolysis and Drain Placement for a 20-year-old female patient suffering from recurrent loculated ascites following a right hemicolectomy for abdominal tuberculosis (TB).
Chief Complaints
A 20-year-old female patient presented to the Gastroenterology Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of intermittent abdominal pain over the last month. Ten days ago, she developed generalized, non-radiating abdominal pain, along with recurring abdominal distension and discomfort after meals. She also had intermittent bilious vomiting about three days ago.
For the past three years, she has experienced similar symptoms, including reflux, which have been managed with oral antacids for the last year.
Medical History
Delving further, it was understood that the patient underwent a laparotomy for intestinal obstruction in 2014, followed by adhesiolysis with bowel resection. Post-surgery, she received antitubercular treatment (ATT) for four months but later defaulted on the treatment. A CECT scan evaluation revealed peritoneal thickening with loculated ascites and a suspected ovarian mass, possibly a germ cell tumor, along with moderate loculated ascites. Ascitic fluid analysis was negative for AFB, and serum CEA levels were within normal limits. The patient had no other comorbidities.
The previous findings, including peritoneal thickening and a suspected ovarian mass, raised concerns about potential recurrence or related pathology, necessitating further evaluation and management.
Diagnosis
Upon admission to PACE Hospitals, the patient’s vital signs were stable. Following a detailed physical examination, it was noted that she had been suffering from intermittent abdominal pain for the last month.
The diagnostic tests revealed recurrent loculated ascites, indicating a buildup of fluid in the abdomen, which appeared to be a complication following her previous right hemicolectomy for abdominal tuberculosis (TB).
Surgical procedure
Following discussions with Dr. CH Madhusudan, the Consultant Surgical Gastroenterologist, it was concluded that an exploratory laparotomy, including adhesiolysis and drain placement, would be the best course of action for the patient’s treatment.
After being admitted with the aforementioned symptoms, the patient underwent further evaluation and was taken for surgery. An exploratory laparotomy with adhesiolysis and drain placement was successfully performed. This procedure was crucial for addressing bowel obstruction and preventing further adhesion-related complications.
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