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Excision of incarcerated, gangrenous small bowel in a patient with septic shock 

A 49 yr old lady presented to the hospital with a 4 day history of abdominal pain. She was a patient with a high BMI of about 35, known to have Diabetes and hypertension. She was diagnosed to have an incarcerated incisional hernia. Echo at the time of admission showed hypokinesia of the inferior wall. She had a fair LV function with an EF of 58%.

She underwent an emergency laparotomy and incarcerated*, gangrenous**  small bowel was found in an incisional hernia. Gangrenous bowel was excised and end to end anastomosis was done by the surgical team. She developed septic shock post op and required high ionotropic support. She developed oliguric AKI with metabolic acidosis. In view of circulatory shock, she was provided CRRT*** support in ICU for 36 hrs by the Nephrology and intensive care teams. She made a good recovery and renal function normalized. She was discharged in a stable condition. 

*Incarcerated hernia is when a part of the bowel protrudes out of the abdomen and cannot be pushed inside.

**gangrene is the death of a body tissue due to lack of Oxygen suppy

*** CRRT is a 24 hour non-stop dialysis done in patients who are extremely unwell and have kidney failure.

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