We had a patient who is left alone in his life for about ten years. To be more clear he was bedridden for those years. The only thing he will do is eat,sometimes pee and poop, but he rarely walks.
People around him thought it was the attitude of elderly. But none of them know the disease he is Developing secretly in his private part. No body touched him or bothered to talk to him so we cannot know anything about fever or anyother ailments. All of their attention turned to him only when foul smell emanated that's about few days before hospitalisation. A pathetic astonishment awaited when they opened his dhoti.
A huge swelling with multiple foul-smelling pus discharging ulcers over his scrotum.
Disgusting!!!!
Immediately took him to hospital where we seen him very badly dehydrated and anemic.,obeys commands but very few verbal response. He was conscious. Except for Bilateral crepitations and wheeze, Systems were normal. His penis got buried into the swelling. The swelling was irreducible, warm and red,tender to touch. Amazingly he was a vegan without any addictions but with diabetes and hypertension . Such an old poor man.
Ultrasound abdomen- bilateral chronic ureteric obstruction with some duodenal wall thickening.
Ultrasound scrotum- bilateral inguinoscrotal hernia with scrotal skin inflammation features.
Planned for bilateral herniorrhaphy and scrotal exploration with debridement .
He was started with piperacillin tazobactam and iv fluids.
On Foley s catheterization, about one litre of urine was drained following that frank pus came out through that catheter about 200ml.
Blood picture showed leucocytosis,renal failure? Chronic,anemia. Chest X-ray showed pulmonary shadows.
Echocardiogram came up with age related cardiac changes.
Decided and posted him for surgery.
Under general anaesthesia, abdomen opened first through lower abdomen transverse incision in layers. On opening about 2/3rd of small bowel loops were herniated through the defect in the anterior abdominal wall on both sides. The herniated bowel loops were lifted up from scrotum on both sides. Fortunately there is no bowel obstruction. Defect was closed with vicryl. While trying to push bowel loops inside the abdominal cavity it was found that his mesentery got elongated due to chronic bowel drag such that abdominal cavity could not accommodate those herniated bowel loops. Decision of resection and anastomosis was made and executed. With drain tube and on attaining hemostats abdomen closed.
Following that scrotum was opened, yaks very foul smelling.
Necrotic areas were removed. Hernial sacs were identified and closed. Scrotal skin was closed and approximated following debridement. Care was taken not to injure urethra.
He was shifted to intensive care with ventilator support.
Surgery was completed without major blood loss.
Vitals got stable. Abdomen became soft and extubated on second post operative day.
But his renal parameters were On its rise, rales and rhonchi never decreased. He was desaturated on post op day three but came up with diuretics and nebulisers. Nephrologist added the dose of diuretics.
He passed flatus with sluggish bowel sounds,and appeared well on fourth post operative day.
Unfortunately on fifth post op night he again desaturated, he was intubated and kept on ventilator. Few hours later, he desaturated again with bradycardia. With in minutes, there was a cardiac arrest.
CPR started ,every efforts were made as per ACLS protocol, but life could not be revived.
He is dead.
Ofcourse,loss at his age would not bring much tragedy to his family yet nature proved its superiority over medical science again.
Cause of death:
Cardiorespiratory arrest
Renal failure
Sepsis
Fournier s gangrene
Diabetes mellitus
Systemic hypertension
Bilateral inguinoscrotal hernia
People around him thought it was the attitude of elderly. But none of them know the disease he is Developing secretly in his private part. No body touched him or bothered to talk to him so we cannot know anything about fever or anyother ailments. All of their attention turned to him only when foul smell emanated that's about few days before hospitalisation. A pathetic astonishment awaited when they opened his dhoti.
A huge swelling with multiple foul-smelling pus discharging ulcers over his scrotum.
Disgusting!!!!
Immediately took him to hospital where we seen him very badly dehydrated and anemic.,obeys commands but very few verbal response. He was conscious. Except for Bilateral crepitations and wheeze, Systems were normal. His penis got buried into the swelling. The swelling was irreducible, warm and red,tender to touch. Amazingly he was a vegan without any addictions but with diabetes and hypertension . Such an old poor man.
Ultrasound abdomen- bilateral chronic ureteric obstruction with some duodenal wall thickening.
Ultrasound scrotum- bilateral inguinoscrotal hernia with scrotal skin inflammation features.
Planned for bilateral herniorrhaphy and scrotal exploration with debridement .
He was started with piperacillin tazobactam and iv fluids.
On Foley s catheterization, about one litre of urine was drained following that frank pus came out through that catheter about 200ml.
Blood picture showed leucocytosis,renal failure? Chronic,anemia. Chest X-ray showed pulmonary shadows.
Echocardiogram came up with age related cardiac changes.
Decided and posted him for surgery.
Under general anaesthesia, abdomen opened first through lower abdomen transverse incision in layers. On opening about 2/3rd of small bowel loops were herniated through the defect in the anterior abdominal wall on both sides. The herniated bowel loops were lifted up from scrotum on both sides. Fortunately there is no bowel obstruction. Defect was closed with vicryl. While trying to push bowel loops inside the abdominal cavity it was found that his mesentery got elongated due to chronic bowel drag such that abdominal cavity could not accommodate those herniated bowel loops. Decision of resection and anastomosis was made and executed. With drain tube and on attaining hemostats abdomen closed.
Following that scrotum was opened, yaks very foul smelling.
Necrotic areas were removed. Hernial sacs were identified and closed. Scrotal skin was closed and approximated following debridement. Care was taken not to injure urethra.
He was shifted to intensive care with ventilator support.
Surgery was completed without major blood loss.
Vitals got stable. Abdomen became soft and extubated on second post operative day.
But his renal parameters were On its rise, rales and rhonchi never decreased. He was desaturated on post op day three but came up with diuretics and nebulisers. Nephrologist added the dose of diuretics.
He passed flatus with sluggish bowel sounds,and appeared well on fourth post operative day.
Unfortunately on fifth post op night he again desaturated, he was intubated and kept on ventilator. Few hours later, he desaturated again with bradycardia. With in minutes, there was a cardiac arrest.
CPR started ,every efforts were made as per ACLS protocol, but life could not be revived.
He is dead.
Ofcourse,loss at his age would not bring much tragedy to his family yet nature proved its superiority over medical science again.
Cause of death:
Cardiorespiratory arrest
Renal failure
Sepsis
Fournier s gangrene
Diabetes mellitus
Systemic hypertension
Bilateral inguinoscrotal hernia
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