By Tedler D. Depaynos, MD
It was just after lunch when the 53 yrs. old male patient was rushed into the Emergency Room. He has been suffering from gradual abdominal distension for the past 3 days accompanied by gradual abdominal discomfort which eventually became painful. Although he claims that the pain was still tolerable, his wife insisted that he should be brought to the hospital for any way he is covered with adequate insurance and Philhealth.
Since he underwent surgery for his inflamed gallbladder 8 months ago, the initial impression of the admitting MDs was probably Intestinal Obstruction secondary to Post-Operative Adhesions. Adhesions of the intestines secondary to scarring may constrict the intestines causing partial or even complete obstruction. The impression was buttressed by the abdominal x-ray reading of “beginning intestinal obstruction” with the “dilatation of some of the small and large intestines”.
He was placed on close observation and monitoring and the routine laboratory tests were requested to prepare him for possible surgery. His past medical records were also reviewed routinely.
What was very significant was that he was previously diagnosed to have a “Chronic Renal Failure” and despite his abnormal lab results during his previous operation, he never underwent dialysis. The wife claims that the patient was adamant because he never felt anything “abnormal” after his previous gallbladder surgery. This would explain the extreme blood pressure of the patient reaching 200/110. Actually, this is one of the manifestations of renal failure, severe hypertension.
The impression that his “abdominal distension” was due to electrolyte imbalance was then entertained so that an aggressive correction of the abnormality was done. He was referred then to a Nephrologist MD who ordered emergency dialysis.
With the partial correction of the imbalance of his electrolytes, the abdominal distension reduced and pain eventually disappeared. His bowel movements returned to normal after a few days. The Medical Interns assigned to him were teasing that he was lucky not to undergo another surgery.
This is one of the serious complications of patients with renal failure who refuse to undergo dialysis. They develop significant electrolyte imbalance which may cause paralysis of the abdominal intestinal contents. With the destruction of the kidneys, the unwanted substances in the body are accumulated and become eventually toxic. They are removed thru the process of dialysis which functions as an artificial kidney. With this lesson, the patient promised to undergo the procedure regularly. He insisted, however, to be discharged soonest despite the recommendation of the Nephrologist MD that he should undergo blood transfusions to correct his significant anemia. This was also explained to the patient as a complication of his kidney problem and if not for the insistence of his wife, he nearly refused as he insisted that his palms are not yet pale.
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