A 30-year-old male presented with fever for 8 days and abdominal pain for 1 day. He underwent an exploratory laparotomy that revealed a 2x2 cm ileal perforation 0.5 feet from the ileocecal junction. The perforation was primarily repaired and a loop ileostomy was fashioned 1.5 feet from the ileocecal junction. On examination, the midline incision was healing well without discharge and the stoma was functioning normally.

1. CASE PRESENTATION
Dr Jitendra Kumar(JR3)
Dept. of Surgery,
MLB Medical College,Jhansi

2. I am presenting the case of Mr.Anand Verma 30 year male,resident of
Gumnawara,Jhansi labourer by occupation belonging to low socioeconomic
status presented with chief complaints of –
●Fever on and off with chills and rigor lasting for 8 days×15 days back
●Pain in lower abdomen lasting for one day 7 days back

3. History of present illness
●Patient was apparently asymptomatic 15 days ago when he developed
fever with chills and rigor which was intermittent in nature with no diurnal
pattern ,not associated with any other symptoms relieved by taking oral
medication prescribed by local practitioner.
●Patient complaint of pain in lower abdomen 7 days back which was acute
in onset, colickey in nature ,not radiating to anywhere,associated with
nausea ,not aggravated or subsided by changing posture,not releived by
taking oral medication for which he came to emergency and admitted and
exloratory laparotomy was done on same day.On exploratory laparotomy
,2×2 cm ileal perforation 0.5 feet proximal to IC junction was found for
which primary repair done and loop ileostomy was made 1½ feet proximal
to IC junction.

4. Negative History
No history of:
●Cough with sputum
●Evening rise of temperature
●Bleeding PR
●Burning micturition

5. Personal history
●Alcoholic and smoker×8 years.
●Patient is on mixed diet.
●Sleep is adequate.

6. Past History
●No history of tuberculosis, hypertension ,diabetes mellitus.
●No history of any surgeries in the past.

7. Family history
●No history of similar illness in other members of family

8. Summary
●A 30 year male presenting to emergency with complaints of pain in
abdomen for one day and fever for a week had undergone exploratory
laparotomy with finding of single ileal perforation ½ feet proximal to
ileocecal junction for which primary repair done followed by loop ileostomy
fashioned 1½ feet proximal to ileocecal junction.

9. General Survey
●Patient is lying supine on couch.
●Patient is afebrile,well oriented to time,place and person.
●Blood pressure is 122/78mm Hg in left brachial artery.
●Pulse rate is 78beats per minute,regular,normovolemic with no radioradial
radiofemoral delay.
●Icterus is absent.
●Pallor is absent.
●No lymphadenopathy,cyanosis,clubbing,pedal edema

10. ABDOMINAL EXAMINATION
INSPECTION
●Abdomen is flat.
●Midline stitched incision is present.
●Stoma with collection bag is in right side of abdomen lateral to umbilicus.
●Collection bag containing about 100 ml of semisolid, yellowish content
with foul smell.
●Drain insertion wound on left lower and right lower abdomen.
●No visible pulsation,peristalsis and dilated veins seen.

11. Palpation
●Skin temperature is normal.
●Abdomen is soft,non tender,midline incision extending 7cm above and 5
cm below the umbilicus without any gaping or discharge.
●Loop ileostomy on right side of abdomen 4 cm away and 3 cm below the
level of umbilicus.
●No palpable organomegaly/lump.
●All hernial sites are normal.
●Renal angles are clear.
●No evidence of free fluid in abdomen.

12. DRE
●Perianal skin is normal.
●Anal tone is normal.
●No growth palpable.
●Mucosa is freely mobile over prostate.

13. Percussion
●No evidence of free fuid in abdomen.
●Liver dullness started from 5th
right intercostal space upto right costl
margin.

14. Auscultation
●Normal bowel sounds are present .

15. Summary
● A 30 year male presenting to emergency with complaints of pain in
abdomen for one day and fever for a week had undergone exploratory
laparotomy with finding of single ileal perforation ½ feet proximal to
ileocecal junction for which primary repair done followed by loop ileostomy
fashioned 1½ feet proximal to ileocecal junction.
●On examination ,midline stitched wound is healthy without any discharge
and stoma is functioning with an average output of 300ml
semisolid,yellowish,foul smelling content per day.

16. ●Thank you!!!