So this 24 year old is brought by his relatives and neighbours at 2.00 am on a hot muggy july night. He was having fever for last 15 days and complains of increasing pain in abdomen since last five days. He was looking worse than before so they brought him to the hospital emergency. The patient is obviously in pain with sweat covering his forehead holding his stomach. Look for his radial pulse; hardly palpable. His arms and legs are cold and clammy-of couse – he is in shock. His abdomen is tense and tender. He is suffering from peritonitis and that is most likely due to perforation in his gut. X-ray of abdomen shows presence of free gas under the diaphragm confirming the clinical impression.
This requires an urgent operation- a laparotomy to repair the defect. So on to the operating table after preparation (will be subject of another post). Abdomen is full of gut content with foul smell. The mess is cleaned and peritoneal cavity washed with warm saline. Rent in the ileum is repaired and abdomen closed after inserting a drain. Keep fingers crossed in the post operative period as the patient recovers and improves in the next 4 to 5 days. A seemingly simple task with many a pitfalls successfully completed.