Indexing Title: MJCABAHUG’s Medical Anecdotal Report [04-2]

MAR Title: S/P Appendectomy patient who had Acute Renal Failure

Date of Medical Observation: April 2004

Narration:

This is a case of a 26-year-old male who came in because abdominal pain. 1 day prior to admission patient had severe epigastric pain which later shifted to the right lower quadrant of the abdomen associated with nausea and vomiting and slight lumbar pain.  Patient sought consult with a private doctor and CBC and urinalysis was done which revealed slight increase in WBC and pus of 10-15 and RBC of 2-6.  He was given unrecalled antibiotic and was sent home.

Few minutes prior to admission persistence of abdominal pain prompted consult at Family Medicine Emergency Room and urinalysis was done which revealed pus  2-4 and RBC 2-4. Patient was referred to surgery was diagnosed Acute Appendicitis, was admitted and was scheduled for operation.

The appendectomy was uneventful with the operative findings of acute perforative appendicitis with localized peritonitis.

Two days post-op, patient started to have high grade fever and slight abdominal pain. Abdominal findings were unremarkable. For 2 more days despite the giving of intravenous Paracetamol round the clock, patient still had high grade fever and noted decreasing amount of urine per hour until had anuria. Patient was referred to Internal Medicine, patient was diagnosed with acute renal failure (ARF) probably secondary to acute tubular necrosis (ATN).  Patient underwent several dialysis sessions and now is almost back to his daily normal chores. 

Insights (Discovery, Stimulus, REINFORCEMENT):

We should always remember that though the disease processes of our patients are typical there are still those patients with other concomitant diseases. we should always take note of the past medical history of our patients.