Surviving House Calls

I was oncall last 2 days. Tat was an eventful call, cuz i oncall with a ‘Jonah’ MO. That was this patient, referred from a peripheral hospital. 60 year old malay lady, known case of diabetes melitus, hypertension, congestive cardiac failure and chronic kidney disease. She complain of right abdominal pain with vomiting and diarrhea. The working diagnosis was, 1) Sepsis secondary to ? source, TRO Pneumonia, 2) Acute kidney injury on chronic kidney disease, 3) Underlying DM, HPT, Chronic kidney disease, Congestive Cardiac Failure. She was having spiking temperature with urea about 44.0 and ABG of metabolic acidosis.

Patient was attended by MO oncall in A&E. He then call me thru the ward and asked me to trace the PT/INR and then to do a Peritoneal Dialysis(PD) for this patient after reviewing the PT/INR. PT/INR results came back normal and I was requested to PD this patient.

So then I did the PD for this patient. I inserted the PD cathether into her abdomen. She complain of abdominal pain. Managed to run in 1 litre of hypertonic fluid. But when I tried the outflow, initially came out clear fluid, but then came out about 50-100cc of turbid, yellowish fluid with some whitish material. Being afraid of perforating her bowel, I quickly alerted the MO oncall.

MO came and see this patient. After looking at the PD fluid, he said ‘Its shit!!! And U r in deep shit!!!’ Then he said ‘Initially we planned this patient for maximum medical management, but now that u have perforated her bowels, we have to HD this patient!!!’ Now that he has tonnes of work to do, he was kinda irritated with wat I has done.

We then referred this patient to surgical, TRO Perforated viscus. Also refer to GA for Haemodialysis via femoral catheter. I got myself into writing referral the referral letters.

The following day, the surgical team came to review this patient, their impression was, TRO perforated viscua. They then planned this patient for exploratory laparotomy. Patient’s condition was optimised and then she went for exploratory laparotomy.

But, thanks to God’s wondrous grace. Post op diagnosis was appendicular abscess and pus collection over right illiac fossa. Bowel was normal!!! Patient was actually having sepsis secondary to appendicular abscess. and the turbid yellow fluid during my PD insertion was the pus discharge from the appendicular abscess.

I dunno whether I will be requested to present a morbidity review on this. But Im glad that, my so-called ‘Traumatic PD’ lead to the correct diagnosis. She is currently in ICU. Pray that she will walk out healthy….