Dear All,
Please see the medical report below and give us your opinions, suggestions such medication or surgery ... how to ease the patient abdominal pain and thrombosis and to help her to lead normal living.
Many Thanks

Patient name: Yassmin
Sex: Female
Old: 36 yeas
Patient Nationality: Egyptian
Marital status: married and have one child 12.5 years old patientold
Occupation: Housewife

• Female patient named Yassmin was pregnant after marriage at 16-7-2002 and after delivery there was postpartum hemorrhage followed by deep vein thrombosis at day 7 starting at aortic bifurcation
• The patient complaint from menorrhagia and diagnosed to be endometriosis via diagnostic laparoscopy and electro cauterization of these points of endometriosis was done followed by medical treatment for 8 months.
• The menstruation stopped for 3 months after stopping treatment and the patient received primarin tab up to 16 tab /day for 1 year and stopped due to the hormonal changes.
• The patient diagnosed to be helicobacter pylori infection (abdominal pains diarrhea vomiting for more than 1 month ) by endoscopy and after trial of medical treatment the patient started complaining from constipation and abdominal pain and diagnosed as adhesive intestinal obstruction post appendectomy (since 17 years old patient). adhesiolysis was done with improvement .
• Patient was readmitted after short time with the same complaint; colonoscopy was done with no results
• The decision was to do partial colectomy .
• Partial colectomy was done and there was one motion every 4 days , postoperatively and gradually increased to one motion /18 days.
• Patient underwent MRI defecography and colonic transit time and rectal inertia was diagnosed.
• Levatorplasty was done with partial improvement followed by deteriorations.
• Re exploration for total colectomy was done and Proceed mesh inserted. post operative, there was wattery diarrhea followed by obstruction again .
• Another operation for proctectomy and ileoanal anastmosis .
• Postoperatively there was severe abdominal pain and at 1-11-2011 the patient readmitted with fecal fistula (multiple opening of anterior abdominal wall)
• Exploration and removal of the mesh and resection of part of small intestine and another mesh inserted (biologic) followed by fecal fistula again With amount (150 to 500 ml) , meanwhile there was deep vein thrombosis again
• Patient readmitted to Arab Contractor Hospital at 25-3-2012 with total parenteral nutrition course for 5 weeks , and trial of fibrin glue injection with no result .
• 6 months later ,exploration was done and adhesiolysis with closure of the fistulae of small bowel with improvement of the general condition.
• Laparoscopic cholecystectomy was done 1 year later
• Nowdays the patient complains from recurrent severe abdominal pains
• Evacuation done only with oral adiminstration of 200cc mannitol 20%