Q) A 68 year old man undergoes repair of infra renal aortic aneurysm. On 2nd POD he has abdominal pain, bloody diarrhea and tachycardia. BP is 120/70. Abdomen is mildly distended and tender especially in the left lower quadrant.
How will you proceed
a) Send stool for clostridium and spores
b) CT Abdomen
c) Exploratory laparotomy
d) Higher antibiotics
Ans b
Get a contrast CT Abdomen as bowel ischemia is a likely diagnosis
Incidence of bowel ischemia after repair of aortic aneurysm is around 2-6%. It is because of loss of inferior mesenteric artery artery at the time of surgery and inadequate colonic collaterals.
Spores and clostridium difficle diarrhea occurs after prolonged antibiotic use. Also there is no bloody diarrhea in it.
Exploratory laparotomy will be required after CT Shows full thickness gangrene and not before
Antibiotic escalation will not help at this stage.
