Behind the knife the surgery podcast where we take a behind-the-scenes intimate look at surgery from leaders in the field

Okay, welcome back to another clinical challenges cases with behind-the-knife team. We're going to old school today

We have two of the original members. I'm here with Scott Russell steel. I'm Jason Bingham Scott

It's good to talk to you buddy. How you doing?

Doing great. You're good to have you back home. Oh, thanks a lot

Well, if it's okay with you, I think we'll just dispense with the pleasantries

I think people know who you are. They don't care who I am so if it's okay with you

Let's go ahead and get into the case back it out

Okay, Scott so our patient is an 80-year-old female with three days of nausea, distension and abdominal pain

Her last movement bow movement was four days ago and she reports increasing problems with constipation over the past year

She reports that she is not passing flatus. No significant pass medical or surgical history on exam her abdomen is

Distended and tempanic, but it's otherwise soft and non-pair to kneel

You know that she's got a micrositic anemia on her laboratory workup with a normal white blood cell count and otherwise

Unremarkable

The yard went ahead and got an x-ray which shows a distended right and transverse colon

With up to 10 centimeters at its greatest point of distension with no gas or distal in the distal cold

Interrect them

You do not see any small bowel or gastric distension. So just hearing that

What's you know what's going through your mind? What do you think? Yeah, so that's great

So you know a lot of times what I try to tell people is the first thing that comes to your mind that we pretty much always do is

Do I have time versus an absolute emergency?

Obviously, it's an absolute emergency a negative or the operating room that that you're kind of diagnosing and working up all at the same time

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