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Images in Surgery
from Swiss Knife 3/2020
by MetroComm AG
Case Description:
A 17-year-old male presented to the emergency department with acute abdominal pain. The patient describes the pain as sharp with an abrupt onset approximately four hours ago. The pain is located in the lower abdomen and radiates to the right costal margin. He cannot remember having had similar pain in the past. The last bowel movement dates from the same morning and was without particularities.
The past surgical history includes several operations in early childhood, the last one at least at the age of two. He does not remember the indication for these operations. The patient does not have any other medical problems and does not take any medications.
Physical Exam: The patient is in distress, but hemodynamically stable. The whole abdomen is tender and painful to palpation, with a point of maxiCase contributed by Beat Möckli and Michele Podetta (Genf) mum pain in the right iliac fossa. No abdominal guarding or rigidity, negative Blumberg sign. A midline laparotomy scar is well healed without a hernia.
Laboratory Values: Hb 142 g/l, Leucocytes 9.2 x 109 /l, CRP 1 mg/l, ASAT 21 U/l, ALAT 21 U/l. The rest of the laboratory values was within normal limits.
What is the correct operation to treat this patient’s condition?
• Laparoscopic Appendectomy • Wedge resection of Meckel’s diverticulum • Ladd’s procedure • Laparoscopic adhesiolysis • Exploratory laparotomy with bowel resection or stricturoplasty depen
ding on intraoperative findings
