2.4 Treatment plan
Due to the exhibiting symptoms of Peritonitis, we candidate her for urgent operation after fluid resuscitation and administration of pre-operative broad-spectrum antibiotics. Under general anesthesia, the stomach was decompressed with a nasogastric tube. Exploratory laparotomy showed a twisted Ileoileal invaginated part at 20 cm from the ileocecal valve. (Figure 1a) At first, we tried to untwist the volvulus, then freed the 20 cm invaginated part by milking from the distal region. Eventually, the 10 cm necrotic area was approved as the small intestine duplication (Figure 1b). Because of the whole thickness necrosis and the impossibility of recovering the invaginated part’s circulation, the decision was made to accomplish resection and anastomosis surgery. The patient was discharged from the hospital after 96 hours without any complications or specific events. Histopathological findings confirmed pan-necrosis in the resected specimen. (Figure2)