Volvulous of gut due to Ascaris Case Presentation Pediatrics surgery Bio-data • 10 years old female, resident of Thatta, admitted through emergency in pediatrics surgery ward, CHK on 1-1-2011. Presenting complaints • Abdominal pain…2 days. • Vomiting…2 days. • Bleeding PR. H.O.P.C • According to patient’s mother, patient got abdominal pain, gradual in onset, colicky in nature, more in umbilical region associated with green colored vomiting. Patient also passed stool with fresh blood and also passed worms. Patient has history of contact T.B to brother. Examination • Patient was looking pale, well oriented with time, place and person, irritable lying on bed. VITALS; • B.P=100/60 mm/hg. • Pulse=105 b/min. • Temp=100 “F. • R/R=30 bth/min. • Weight=20 kg. Cont… • • • • • • • Anemia=+ve. Jaundice=-ve. Dehydration=+ve. Edema=-ve. Cyanosis=-ve. Clubbing=-ve. Lymph-nodes=cervical palpable. Cont… • Abdomen=tense, tender, no visceromegaly. • Gut sounds=not audible. • DRE=normal anal tone, no fissure or polyp, empty rectum, blood tinged finger. Labs • • • • • • • • • • HB=10.4 gm/dl WBC count=18.0x10 E9/L Platelets=186x10E9/L SGPT=31 unit/l. Urea=26 crea.=0.5 Na=136 K+=3.0 Cl=99 Ca=7.8 • P.T=patient=19.4 Sec • Control=12.0 Sec • INR=1.64 Cont… • U/S abdomen= thick walled fluid filled bowel loops are seen with no peristaltic movements. Cont… • Emergency exploratory Laparotomy done on 2nd Feb. 2011. Operative findings were: Globular swelling about 5x6 cm. at anti mesenteric border, twisted gut 10-20 cm. from dj junction, resection of 10-15 cm. of gut and end to end anastomosis done. Worms were also taken out. D/D • Volvulus of gut=? • ………………………..? • ………………………..?