Indexing Title: HTURINGAN's Medical Anecdotal Report [04-2]

MAR Title: Patient presenting with a history of intestinal obstruction which turned out to be a strangulated hernia (Nov. 2003)

Date of Medical Observation: November 9, 2003

Narration:

This is a case of  S.A. 54 year old male who came in due to  5 days history of abdominal pain and loose watery stools. 

Patient sought consult 3 days prior to admission at the Family medicine emergency and was treated as acute gastroenteritis. 

However persistence of symptoms prompted another consult at the emergency room and was subsequently referred to surgery for abdominal evaluation. 

The history given by the patient was the same and on physical examination, right lower quadrant tenderness was noted. 

On further examination an incarcerated right inguinal hernia was noted.
The patient did not volunteer this information since it was a chronic incarceration and only noticed that it slightly became larger and painful to touch 5 days ago, the time when the abdominal pain was noted. 

He was not able to correlate the abdominal discomfort to his hernia. 
The Patient was booked for emergency herniorrhaphy. 

Upon opening up the cecum and appendix was noted to be strangulated, violaceous, with multiple serosal tear.

Along with my consultant we performed a cecal resection with colo-ileal anastomosis, and herniorrhpahy, right.

The patient went home after two days post-op, thankful that he was given a second life.
 

Insights (Discovery, Stimulus, REINFORCEMENT):

Sometime no matter how meticulously we elicit our history, we may be misled by certain information that the patient thinks is not pertinent to what he is currently feeling. 

So as physicians and surgeons we must always be alert and aware not to rely on history alone and must always try to do a complete physical examination on our patients so as not to miss physical findings crucial to the case at hand.