Abdominal pain
A 62yr old lady presents to the Emergency Department complaining of a painful right hip after slipping and falling onto the concrete ground on her right side.
She has a past history of a right hip replacement about a month ago for unexplained AVN of the femoral head. And she also has a history of alcoholic pancreatitis for which her last admission was about 15 months ago. Other than that, she is normally fairly fit and well!
On examination, her general condition is stable, she is apyrexial and her other obs are stable. Her right hip is tender to palpate but there is no obvious shortening or external rotating of the limb.
She has an xray that show the following:
She is admitted placed nil by mouth from midnight, put on IV fluids, prescribed IV morphine for pain relief and scheduled for theatre the next day.
At around midday the next day, she complains of a 2 hour history of worsening abdomnal pain and distention. She claims not to have opened her bowels for the past 2 days and last passed flatus several hours ago. On examination she is apyrexic, with a normal BP, pulse, resps and sats. But her abdomen is obviously distended, very tender and she is guarding!
She has bloods taken that show
An xray of her abdomen shows
Three hours later, the pain has not subsided, she becomes pyrexic at 38.2 deg celsius and generally looks unwell. She has a CT scan as shown below
So questions
- What is the incidence of such type of fractures?
- Based on her initial abdominal complaints and presentation prior to the temperature spike, what are your possible differentials?
- What does the CT show and how should she be managed?
- How should she be managed on the overall taking into account all her problems on this admission?
