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We report the case of a female patient, aged between 50 and 60 years old, who presented with mechanical ileus sustained by intra-peritoneal adhesions. Her medical history was characterised by a transanal, endorectal pull-through for Hirschsprung’s disease of the left colon during her infancy; moreover, she underwent bilateral ovarian resection for pelvic abscess. These previous surgeries caused multiple hospitalisations for recurrent intestinal occlusions, two of which requiring surgical laparotomic adhesiolysis.
The patient presented to the emergency department having abdominal pain, bloating and vomiting, associated with bowel not opened to faeces in the past 48 hours. Blood examinations were unremarkable except for a slight leucocytosis (white cell count 13×109/L). Arterial blood gas analysis revealed a pH and lactate levels within the normal range. Contrast-enhanced abdominal CT scan confirmed the small bowel distension associate with an ileal transition point with reduction in bowel calibre and diffused intraperitoneal free fluid.
Given the clinical stability and laboratory tests almost unremarkable, we initially attempted a conservative treatment by means of a nasogastric tube and the administration of Gastrografin. However, 36 hours later, this latter manoeuvre caused an important paradoxical diarrhoea with important fluid and electrolyte loss, leading to hypovolaemic shock.
Given her clinical condition, once restored the haemodynamic stability, 48 hours after the gastrografin administration, the patient …
Handling editor Runjan Chetty.
Contributors All authors read and approved the manuscript. Conceptualisation of the study: MF. Investigation: CF. Supervision: ML, EG, RS, AMI, CG. Writing original draft: MF, CF. Review the article: MF, ML, RS and MAZ.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.