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Case Report
Acute febrile abdomen resistant to antibiotic therapy: A case report and review of the literature
1 Radiology Department, Mohamed the Fifth Military Instruction Hospital, Mohamed V University, Rabat, Morocco
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Neftah Camelia
Radiology Department, Mohamed the Fifth Military Instruction Hospital, Mohamed V University, Rabat,
Morocco
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Article ID: 101100Z01NC2020
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Camelia N, Meriem E, Ayouche O, El Bakkari A, Dieukedao F, Boumdin H. Acute febrile abdomen resistant to antibiotic therapy: A case report and review of the literature. Int J Case Rep Images 2020;11:101100Z01NC2020.ABSTRACT
Introduction: Digestive perforation can present in a variety of clinical and radiological aspects. In all cases, computed tomography (CT) scan is of urgent necessity as it can contribute to the positive diagnosis as well as etiological identification that can change therapeutic management. We have to outline the importance of the difference between surgical free peritoneal perforations and covered perforation. Covered perforation may manifest as acute febrile abdomen evolving for days resistant to probabilistic antibiotic therapy before primary consultation.
Case Report: We expose the case of a 50-year-old patient, with a history of chronic smoking, consulted in the emergency department for a subocclusive syndrome evolving for six days. An abdominal CT: The diagnosis of covered duodenal perforation was retained. Due to a development of hypovolemic shock, which did not recede with vasoactive drugs. The decision was to do a laparotomy with peritoneal lavage with suture of the anterior duodenal perforation and a drainage of the abdominal cavity. The evolution was characterized, five days after, by the death of the patient.
Conclusion: Gastroduodenal perforations in free peritoneum result in pneumoperitoneum, which is usually voluminous, especially if the lesions sit in its anterior surface. Partially covered gastroduodenal perforations result in local changes in the peritoneum corresponding to localized peritonitis. In such cases, however, the ulcerative lesion must be proven by the localized interruption of mucosal enhancement. These elements are valuable for accurate positive diagnosis, but also for therapeutic management.
Keywords: Computed tomography, Duodenum, Febrile abdomen, Perforation
SUPPORTING INFORMATION
Author Contributions
Neftah Camelia - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Edderai Meriem - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Othman Ayouche - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Asaad El Bakkari - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Fabrice Dieukedao - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Fabrice Dieukedao - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Hassan Boumdin - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2020 2020 Neftah Camelia et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
