Case History and Examination.
A 23-year-old patient presented to the emergency department of trauma
center Civil Hospital Karachi with complaints of fever for two days and
pain at the epigastric region and at the post-surgical site for three
days, following a laparoscopic cholecystectomy performed five days
prior. The pain started at the epigastric region radiating to the tip of
shoulder and at the surgical site. The pain was sudden and sharp,
aggravated by eating , and relieved with analgesics for few hours.
However, since the last day, the pain had become more severe and was
unrelieved by oral analgesics. The pain was accompanied by vomiting,
which was non-projectile, with two episodes per day containing food
particles and no associated bleeding. Fever was sudden in onset,
intermittent, and undocumented, associated with chills and rigor.
patient had undergone a laparoscopic cholecystectomy for chronic
cholecystitis secondary to cholelithiasis five days prior to
presentation and had no significant past medical history. At the time of
presentation, the patient reported normal bowel and bladder movements
and appetite.
On examination, the abdomen was soft, with tenderness at the epigastric
and infraumbilical surgical site, a tympanic sound on percussion and
normal bowel sounds were noted. All other systemic examinations were
unremarkable. Except the patient had mild yellowish discoloration of
sclera. On admission vitals were: temperature of 101°F, blood pressure
of 97/63 mmHg, heart rate 100 bpm, breathing rate of 20 bpm, and
saturation (SpO₂) 96% on room air. The patient weighted 56 kg and was
alert and oriented to time, place, and person. Glasgow Coma Scale (GCS)
revealed a score of 15/15.