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A Case of the Week

Case 57

 We present five patients with ileus who were initially diagnosed as adhesive (simple) ileus on non-enhanced CT, implying that no surgical management might be necessary. However, following day, two of the five cases had to receive surgical operation which revealed strangulation ileus associated with necrotic small bowels.
 Case 1(Figure 1): a ninety one-year-old female came to our hospital for whole abdominal pain. She had previously undergone a Caesarian operation in the youth. Laboratory test revealed white blood cell 18660, neutrophils 93.8%, CRP 0.55 mg/dL.

 Case 2 (Figure 2): a seventy four-year-old male came to our hospital for vomiting and abdominal pain. He had previously gastrectomy for gastric cancer and thereafter, experienced ileus a few times. Laboratory test revealed white blood cell 10290/mm3, neutrophils 84 %, CRP 0.02 mg/dL.

 Case 3 (Figure 3): a fifty two-year-old female came to our hospital for repeated vomiting. She had received an open surgery for duodenal tumor at her age of 21. Laboratory test revealed white blood cell 12280/mm3, neutrophils 81.5 %, CRP 0.23 mg/dL

 Case 4 (Figure 4): an eighty three-year-old female came to our hospital for abdominal pain this evening. She had previously received radiation treatment for uterine cancer. Laboratory test revealed white blood cell 11630/mm3, neutrophils 92 %, CRP 0.01 mg/dL.

 Case 5 (Figure 5): a seventy six-year-old female came to our hospital for abdominal pain and vomiting 4 times after dinner. Laboratory test revealed white blood cell 8780/mm3, neutrophils 91 %, CRP 0.02 mg/dL.


Which cases are necessary to receive laparotomy on non-enhanced CT ?

a. Case 1 (Figure 1)

b. Case 2 (Figure 2)

c. Case 3 (Figure 3)

d. Case 4 (Figure 4)

e. Case 5 (Figure 5)


1.a,b    2. b, c   3. c, d    4. d, e    5. a, e

2017.6.7



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