Dr. Narendra Kumar (Internal Medicine) needs a second opinion on this medical case.
A 76 y/o male is presented with abdominal pain with nausea and vomiting.
6 days prior he had surgery for right femur fracture with proximal intramedullary nail.
He has h/o surgery for appendectomy.
*Blood pressure-125/75 mmhg, HR- 109 beats/min, Respiratory rate-19 bpm, Temp-99.3 degree F.
Abdominal distension on rt side. Other examination is unremarkable.
Hb- 12.1 g/dL, WBC-13.05 × 109/l, C-reactive protein 18 mg/dL.
CT- thickeness of small bowel with free air noted on rt side + perforation of jejunum.
Please give your advice.