This slide is about a case of a patient who presented as an abdominal emergency and loop ileostomy was formed.

1. CASE PRESENTATION
Dr. Narendra Kumar
JRIII
Department of Surgery,
M.L.B. Medical College, Jhansi
STOMA

2.  Patients Name : Manoj
 Age/Sex : 17Y/M
 Religion : Hindu (Unmarried)
 Occupation : Student
 Address : Jhansi

3. CHIEF COMPLAIN AT THE TIME OF ADMISSION
 pain abdomen for 5 days
 Not passing stool and flatus for 2 days
 Abdominal distension for 2 days
14 days back

4. HISTORY OF PRESENT ILLNESS
 History was given by the patient himself and seems reliable
 He was apparently asymptomatic 14 days back when he developed
pain abdomen.
 It was sudden in onset and progressive in nature.
 Pain could not be localized and there was no radiation or shifting
of pain
 Pain increased in movement and did not subside even on rest.
 He was also complain inability to pass stool and flatus
 It was also associated with distention of abdomen which was
diffuse in nature.
 Associated with loss of appetite

5.  Patient also complains of fever 28 days back that lasted for 7
days, was intermittent, not associated with rigors and chills
and was relieved by medications.

6.  No History of –
• Cough with sputum
• Evening rise of temperature
• Burning micturation
• Bleeding PR

7.  On thorough examination, in emergency patient was
found to have- Grossly distended and tense and tender
abdomen with resonant note.
 On Explorative laparotomy
single perforation of size 1cm x 1cm; 5 cms
proximal to IC junction was found, which was
repaired with primary intention and 1 ½ feet
proximal to IC junction, loop ileostomy was
fashioned in the right iliac fossa of the abdomen

8. PERSONAL HISTORY
 No history any Addiction.
 Patient is vegetarian by diet.

9. PAST HISTORY
 No History of TB
 Patient is not diabetic
 No history of any surgery.

10. FAMILY HISTORY
 Not significant

11. EXAMINATION
 General Examination
 Patient lying supine in couch.
 Patient afebrile.
 Well oriented to time place and person.
 BP 108/68 mm of Hg in right arm in supine position.
 Pulse rate 84 per min regular normo volumic no radioradial
or radiofemoral delay.
 Icterus absent.
 Mild pallor present.
 No lymphdenopathy.
 No clubbing.
 No cyanosis.
 pedal edema present bilaterally, pitting

12.  ABDOMINAL
EXAMINATION
 INSPECTION
 Abdomen scaphoid.
 Midline stitched incision with
a gaping wound below the
umblicus
 Stoma with collection bag in
right side of abdomen lateral
to umblicus.
 Collection bag containing
about 100ml of semisolid
yellowish content with foul
smell.
 Drain insertion wound on left
lower abdomen and rt.upper
abdomen present.
 No visible
pulsation/peristalsis/dilated
vein seen.
 All hernia sites are normal.
 External genitalia are normal.
 Back and renal angles are
normal.

13.  PALPATION
 Temperature normal.
 Abdomen soft non tender.
 Midline stitched incision extending 6 cm above and 4cm below
umblicus with a gaping wound below umblicus.
 Loop Ileostomy on right side of abdomen 4cm away and 2.5cm
below the level of umblicus.
 No palpable organomegaly/lump.
 All hernial site are normal.
 Renal angles are clear
 No evidence of free fluid in abdomen.
 DRE -
 No Swelling/Ulcer/Fistula/Fissure/growth.
 Anal tone normal.
 No fecal soiling of examining finger.

15. PERCUSSION
 No evidence of free fluid in abdomen.
 Liver dullness started from 5th right intercostal space
upto right costal margin.

16. AUSCULTATION
 Normal bowel sound.

17. SUMMARY
 17yrs old pt.presented with chief complain of pain
abdomen for 5days .not passing stool , flatus and
abdominal distention for 2 days for which exploratory
laprotomy done with finding of ilial perforation 5cm
poximal to IC junction for which primary repair done
and loop ileostomy made 1 ½ feet proximal to IC
junction.

18. THANK YOU