Posted in surgery

Clinical note 

A 60-year-old agriculturist was referred to the department of ENT for dysphagia of 3-4 days duration. A Registrar who saw the case did rigid oesophagoscopy under GA. The findings were normal. Later in the evening he was called to see this patient who had rigid abdomen. A general surgeon was consulted. He suspected a perforation. An X-ray abdomen (erect) however, was normal. A senior faculty surgeon was consulted who examined the case properly and gave a correct diagnosis. It was a case of tetanus with mild trismus. The patient had injured his left thumb a few days back. The anaesthesiologist acknowledged later that there was some difficulty in opening the patients mouth during endotracheal intuabtion. 

Occasionally, patients undergo gastroscopy for dysphagia which will be normal only to realise later that what he is having is a stroke! ! l. 

© Manipal manual of surgery, fourth edition, 

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