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Not All Turds are Created Equal

Not All Turds are Created Equal. Not All Turds are Created Equal. CC: Abdominal Pain HPI: 25 y old female.

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Not All Turds are Created Equal

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  1. Not All Turds are Created Equal

  2. Not All Turds are Created Equal • CC: Abdominal Pain • HPI: 25 y old female. • Presents with one day of progressive abdominal pain. Generallized, progressive and constant pain. Sudden worsening of pain 2 hours ago. Associated nausea and vomiting. No fever. Bloating. Flatus. • LBM in am (“normal”) • History of same problem one month ago. Admitted to ERH. After Xrays and CT scan was given two bottles of Go-Lytley and discharged the following day.

  3. Not All Turds are Created Equal • PMH: • Anorexia-bulemia • AKA due to severe osteopenia and # non-union • Prescription narcotic dependence • Chronic constipation

  4. Not All Turds are Created Equal • Physical Exam: • HR-120 BP-120/60 RR-18 T -36.7 • Marked discomfort • Chest: clear • CVS: normal • Abdomen: Protruberant, BS+, generallized tenderness, guarding and rebound large right periumbilical mass (mobile)

  5. Not All Turds are Created Equal • Xray

  6. Not All Turds are Created Equal • One month prior

  7. Not All Turds are Created Equal

  8. Not All Turds are Created Equal • Xray • CT

  9. Not All Turds are Created Equal

  10. Not All Turds are Created Equal • Xray • CT • Treatment??

  11. Stercoral Perforation • Definition: “perforation of the large bowel due to pressure necrosis from a fecal mass”

  12. Stercoral Perforation • Incidence: 100 reported cases • Age: 4y-85y (mean=59y) • Mortality: 35% • History of constipation: 60% • Risk factors: • NSAIDs, Antacids, Steroids, Narcotics • Neurologically impaired patients

  13. Stercoral Perforation • Diagnostic Criteria • Ovoid colonic perforation (antimesenteric) • Fecalomas (within bowel or intraperitoneal) • Pressure necrosis at perforation site May be multiple sites of erosion/perforation (27% of cases)

  14. Stercoral Perforation • Sites: • Sigmoid (47%) • Rectum (30%) • Caecum (9%) • Transverse (7%) • Descending (5%)

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