ACUTE ACUTE ABDOMINAL ABDOMINAL

PAINPAIN

Dr Ha Thi Hanh A&EDr Ha Thi Hanh A&E

CASE REPORTCASE REPORT

Mr GRAS PAUL EUGENE 59 YOMr GRAS PAUL EUGENE 59 YO VISIT DATE 15-DEC-2009 23:10 VISIT DATE 15-DEC-2009 23:10 CHIEF COMPLAIN: pain at waits and CHIEF COMPLAIN: pain at waits and

hypogastric.hypogastric. Past history: coronary stenting 2008, Past history: coronary stenting 2008,

dislipidemiadislipidemia Treatment: plavix, Imdur, TahorTreatment: plavix, Imdur, Tahor

Medical historyMedical history: after bringing 2 : after bringing 2 heavy suitcases, patient has had heavy suitcases, patient has had lumbar pain that radiated to lumbar pain that radiated to hypogastric areas from 3 h ago, that hypogastric areas from 3 h ago, that was a sharp, continue pain, he was a sharp, continue pain, he denied vomiting, diarrhea, fever. The denied vomiting, diarrhea, fever. The pain was more and more serious he pain was more and more serious he could not suffer the pain then could not suffer the pain then admitted in FVH.admitted in FVH.

Physical examination and explorationPhysical examination and exploration:: P:99, BP:136/70, T:37, RR:20, SpO2:98, P:99, BP:136/70, T:37, RR:20, SpO2:98, Pain score:08/10, Glasgow:15, W:70 Pain score:08/10, Glasgow:15, W:70 General state: alert, pale, very excitement. General state: alert, pale, very excitement. Heart sound : normal, Lung: clear, no Heart sound : normal, Lung: clear, no

rales, no dyspnearales, no dyspnea Abdomen: supple, pain at right flank and Abdomen: supple, pain at right flank and

RLQ on palpation, blumberg (+/-), RLQ on palpation, blumberg (+/-), MacBurney(+), Murphy(-) MacBurney(+), Murphy(-)

Neuro. System: nucha rigidity(-), neuro Neuro. System: nucha rigidity(-), neuro deficit(-) deficit(-)

DiagnosisDiagnosis: :

- Acute lumbago with radiculopathy - Acute lumbago with radiculopathy

- Right renal colic ?- Right renal colic ?

- Mesenteric artery embolism ?- Mesenteric artery embolism ?

- Dissecting of AAA ?- Dissecting of AAA ? ExplorationExploration: ECG, blood test ,Abdo-: ECG, blood test ,Abdo-

pelvis CTpelvis CT TreatmentTreatment : NaCl PIV, Morphin, : NaCl PIV, Morphin, EvolutionEvolution ??? ???

Evolution: patient was still severe Evolution: patient was still severe abdominal pain and always moving on abdominal pain and always moving on the bed, after injection morphine 2.3 the bed, after injection morphine 2.3 min , put the IV line, he screamed then min , put the IV line, he screamed then SOB, more pale, no pulse, BP:76/53>> SOB, more pale, no pulse, BP:76/53>> perfusion, O2, put the 2perfusion, O2, put the 2ndnd IV line>> IV line>> propose to do Abdominal US at A&E room propose to do Abdominal US at A&E room because patient was very unstable. At because patient was very unstable. At that times abdominal palpation showed that times abdominal palpation showed there was a mass at right abdomen. there was a mass at right abdomen.

00:00 BP:83/50> go to CT 00:00 BP:83/50> go to CT

Abdo-pelvis CT:… Abdo-pelvis CT:… Disposition: call for ICU of FVH , call Disposition: call for ICU of FVH , call

for Tam Duc hospital , call for Cho for Tam Duc hospital , call for Cho Ray hospital,Ray hospital,

Transfer to Cho Ray hospitalTransfer to Cho Ray hospital