Age: 55.0
Sex: M
Vaccine: COVID19
Symptoms: Arthralgia, Computerised tomogram abdomen abnormal, Diarrhoea, Dizziness, Essential thrombocythaemia
Clinical narrative: 05.19.2021:  - I experienced lightheadedness, sore arm, sore shoulder.  Took Advil to relieve soreness.  05.28.2021-06.04.20121: - I started feel like my stomach is bloated-feels full.  06.05.2021: - Stomach continues to feel bloated-feels full.  I started to feel a mild abdominal pain in the evening; the pain progressively  - pain intensified through the early morning.  06.06.2021:  - Abdominal pain continued. vomited.  Took tums & relieved the pain for a couple of hours.  06.07-08.2021:   I called Family Practice & met with Dr since my primary care physician was not available.  I explained to Dr  what I was experiencing; he instructed me to go the Emergency Room  directly.  I headed to the Emergency Room and was later admitted to the hospital (See below for details).   Result:  CT ABD PEL W IV CON CT ABDOMEN AND PELVIS RADIOLOGIST: HISTORY: 55 years Male, presents with periumbilical pain x 3 days- diarrhea . COMPARISON: None. TECHNIQUE: Helical axial contiguous CT images through the abdomen and pelvis following the administration of IV contrast. Oral contrast was not administered. Sagittal and coronal reformats were reconstructed and reviewed. FINDINGS: Limitations: None. Lower chest: There is a small linear bands at the medial aspect of the right middle lobe. There are bilateral dependent changes. Liver: There is a too small to characterize hypodensity at the left liver lobe.. Spleen: Unremarkable. Gallbladder: Unremarkable. Pancreas: Unremarkable. Adrenal Glands: Normal Kidneys: There is a 1.3 cm cortical cyst at midportion of the left kidney. There is a diffuse multiple tries cortical hypodensity at the lower portion of the left kidney.. Stomach: Unremarkable. Bowel: There is no bowel obstruction. There is mild diffuse dilatation of the small bowel loops with liquid contents. There is abrupt transition of the caliber at the distal small bowel loops/terminal ileum compatible with bowel obstruction. Appendix: There are no signs of acute appendicitis. Vessels: Aorta is normal in caliber. PAGE 1 Signed Report (CONTINUED) CT ABD PEL W IV CON Peritoneum: Unremarkable. Lymph nodes: There is no lymphadenopathy Urinary bladder: Unremarkable. Reproductive: Unremarkable. Bones: Unremarkable. Soft tissues: Unremarkable. IMPRESSION: Small bowel obstruction with transition point at the distal small bowel/terminal ileum of indeterminate etiology. Thank you for allowing us to participate in the care of your patient. This CT was performed using the most up-to-date dose reduction software and techniques (including automated exposure control, adjustment of the MA and/or kV according to patient size, and iterative reconstruction technique) in accordance with our continuing efforts to minimize radiation dose while maximizing the diagnostic quality of our images. Released for the hospital.  Restricted to soft food diet.  I still am experiencing abdominal discomfort but no extreme pain.  06.11.2021:   Met with Dr. for follow-up visit as instructed by attending physician as Hospital Center.   06.15.2021:   - I received my 2nd COVID shot no significant adverse reaction; however, I continue to experience abdominal discomfort through 06.19.2021.  06.20-21.2021:  - I started to feel my abdominal discomfort transitioning pain.  The abdominal pain progressively intense; I started to sweat profusely.  I was discovered by my spouse on the bed face down but responsive and was taken to the Emergency Room.     06.21-07-01.2021:   Encounter Diagnosis Abdominal pain (Discharge Diagnosis) - 6/21/21 Bowel perforation (Discharge Diagnosis) - 6/21/21 Intussusception intestine (Discharge Diagnosis) - 6/21/21 Pneumoperitoneum (Discharge Diagnosis) - 6/21/21 Elevated liver enzymes level (Discharge Diagnosis) - 6/30/21 Sepsis, unspecified organism (Final) - Acute respiratory failure, unspecified whether with hypoxia or hypercapnia (Final) - Perforation of intestine (nontraumatic) (Final) - Peritonitis, unspecified (Final) - Severe sepsis with septic shock (Final) - Intussusception (Final) - Fistula of intestine (Final) - Disruption of external operation (surgical) wound, not elsewhere classified, initial encounter (Final) - Family history of diabetes mellitus (Final) - Essential (hemorrhagic) thrombocythemia (Final) - Contact with and (suspected) exposure to COVID19 (Final) - Family history of ischemic heart disease and other diseases of the circulatory system (Final) - Meckel's diverticulum (displaced) (hypertrophic) (Final) - Removal of other organ (partial) (total) as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure (Final) - Personal history of other medical treatment (Final) - Personal history of nicotine dependence (Final) - Other long term (current) drug therapy (Final) - Discharge Disposition: Home - 01  PREOPERATIVE DIAGNOSIS: 1.Pneumoperitoneum 2.Small bowel intussusception 3. Hollow viscus perforation  POSTOPERATIVE DIAGNOSIS: 1.Small bowel perforation 2. Meckel's Diverticulum 3. Intraluminal small bowel mass 4. Large Pelvic abscess 5.Purulent peritonitis  PROCEDURE PERFORMED: 1.Exploratory laparotomy 2.Small bowel resection 3.Abdominal washout 4.Placement of Negative pressure temporary abdominal wound closure device  07.06.2021 - Appointment with Dr. (Infectious disease). Patient is doing well post-surgery and was cleared to return to home state.  07.07.2021: - Appointment with Dr. - post exploratory laparotomy, bowel resection open abdomen June 21, 2021 and return to operating room for small-bowel anastomosis and abdominal closure June 23, 2021.Patient recovering appropriately. Patient states he has been cleared to travel back to home state. Patient instructed to follow-up with his primary care physician and seek gastroenterology referral for colonoscopy to be completed at least 6 weeks after the time of surgery  07.28.2021:  Appointment with Dr. for follow up visit as instructed by attending physician in Hospital.  Dr. recommended 4-8 weeks for recovery with gradual return to work and to schedule an appointment with Dr.  08.05.2021:  Appointment Dr. Patient is doing well status post-surgery.  In hindsight, I am not sure what could have or would have been done differently to prevent the course of events that occurred in another state.  The intensity of his work-up was determined by his symptoms and he was symptom-free shortly after presenting to the emergency department.    It is interesting to note that both episodes occurred shortly after both doses of his Covid vaccination.  I am not sure of the causative link.