A 72-year-old man presented in the orthopedic ward. He had a hemiarthroplasty of his right hip 6 days earlier. He was recovering well initially but later on developed significant abdominal distension. He has not opened his bowels or passed flatus for the 4 days. Medical History: Treatment for a transitional cell carcinoma of the bladder and an appendicectomy. He has a hiatus hernia. Gave up smoking 6 months ago. Physical examination: Blood pressure is 114/88 mmHg.
.Pulse rate is 98/min Abdomen distended with mild generalized tenderness. No hernias and digital rectal examination reveals an empty rectum. Investigations: Hb 10.2 g/dL, WBCs 12.6 billion/L, Platelets 422 billion/L. Na 131 mmol/L, K 3.2 mmol/L, Urea 5.7 mmol/L. Creatinine 78 µmol/L. What is the significance of the right iliac fossa pain in this setting? What does conservative treatment consist of? Source: 100 Cases in Surgery…
