I am referring Mrs Howard who is suffering from an early bowel obstruction due to possible diverticulitis or carcinoma. She has a past history of an ovarian cystectomy and an appendicectomy, as well as a possible spontaneous abortion on 09/01/07.
Mrs Howard initially presented with a two-day history of lower abdominal pain on 20/01/07. This sharp and constant pain came on suddenly and was worsened by changing position but relieved by Valium. An examination found tenderness in the left lower quadrant of the abdomen and a palpable vague mass. Mrs Howard reported a similar pain occurred in December last year, and her last period was in October 2006. Consequently, a pregnancy test and blood tests were carried out. One day later, Mrs Howard reported passing a hard stool coated with bright red blood after three days of constipation.
On review today, Mrs Howard reported worsened symptoms after meals and a failure to pass flatus and stools. Bowel sounds were absent on examination, and the blood tests showed anaemia (haemoglobin 9.3 g/dl, mild left shift).
I consider Mrs Howard is suffering from an early bowel obstruction possibly due to diverticulitis or carcinoma and needs specialist assessment. I would be grateful if you could take over Mrs Howard’s case for surgical management.
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