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)