Rare presentation of community acquired pneumonia resulted i
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• Community-acquired pneumonia can be a challenging diagnosis, with a presentation of acute abdominal pain mimicking a surgical abdomen.

• In pediatric patients pneumonia is considered as the main extra-abdominal cause of acute abdominal pain.

• Abdominal Pain mimics is an entity by itself with a vast differential diagnosis.

• Acute abdomen requires precise and rapid diagnosis and treatment to avoid an increase in mortality.

• Laparoscopy is safe and effective in setting the diagnosis.

A 44 years-old gentleman, heavy smoker, moderate alcohol consumption presented to the emergency department for acute onset of abdominal pain. The pain started one day prior to presentation, was continuous, progressively increasing in intensity, and was localized to the right hypochondriac, lumbar, and iliac regions. The patient reported that the pain did not radiate elsewhere and was associated with multiple episodes of vomiting. He denies any cough, dyspnea, or other complaints.

On physical examination, the patient was febrile, tachycardia, normotensive, and had normal oxygen saturation (SpO2 96%). The abdominal exam revealed abdominal rigidity over the right hemi-abdomen, associated with guarding on the left. The patient’s laboratory studies revealed leukocytosis with neutrophil shift (PMN 86%), and an elevated CRP (61 mg/L). The total bilirubin was elevated. An enhanced CT Scan of the abdomen and pelvis showed mild parietal thickening of the duodenum and at the angle of Treitz. Under general anesthesia, diagnostic laparoscopy was performed by the primary surgeon. The stomach and bowels were intact without any suspicious lesions or inflammatory signs. Surgery was aborted with an inconclusive diagnosis and the patient ameliorated well without any surgical complications.

The fever persisted after surgery, however, the abdominal pain was improving and was still the only complaint. On physical examination, the guarding on the right side slightly improved, while the pain in the right upper quadrant persisted. On routine chest auscultation, new right basal crackles were heard. Chest X-ray was ordered and revealed new right lung base infiltrates consistent with pneumonia, which was confirmed by a chest CT. Only after the second postoperative day did the patient develop a cough and dyspnea. A diagnosis of CAP was done, and the patient was started on proper antibiotic therapy and was later discharged home after improvement.

Source: https://www.sciencedirect.com/science/article/pii/S2210261220307185?dgcid=rss_sd_all
Dr. S●●●●h C●●●●●a S●●●●a S●●●●a and 1 others like this
Dr. S●●●●h C●●●●●a S●●●●a S●●●●a
Dr. S●●●●h C●●●●●a S●●●●a S●●●●a Internal Medicine
So it is important to examine all system before any intervention.
Sep 17, 2020Like