Submitted by Dr CHAN Chin Pang Ian on 3 March 2009
ICU, United Christian Hospital, Hong Kong
History: A young lady having good past health noticed transient facial rash 2 weeks before admission.
She was admitted because of abdominal pain and vomiting for 5 days. She was told to have intestinal obstruction and kidney problem while initially admitted to the hospital in mainland China. A supine AXR was on admission to Hong Kong hospital:
Physical examination showed dehydration, distended abdomen and sluggish bowel sound. CT abdomen with contrast was performed:
Click here to see more images and the answer
.
Blood test showed acute renal failure, normal blood white cell count and negative sepsis work-up. Significant Ryle’s tube bile-stained aspirate output noted (1300ml/day)
Drip and suck with antibiotics coverage and TNP was started, autoimmune markers were checked:
- C3 0.16 C•4 <0.02 •ANA/ANCA normal •CRP <0.1 •ESR 10
- •Anti-ds DNA: >300 Anti-ENA: +ve
Imagining Findings:
- Plain X-ray: dilated bowel
- CT abdomen: dilated bowel with thicken bowel wall, Splenomegaly, Hydronephrosis
Diagnosis:
Intestinal Pseudo-obstruction with newly diagnosed Systemic Lupus Erythematosus
Suggested readings: