Ticket Id: 25867

09/03/2019

Dr. Jose Jiminez

Surgeon
Melbourne Private Hospital
19 Grange Road
Melbourne 3000

Dear Dr. Jiminez,

Re: Mrs Ann HOWARD, Commented [ESL1]: Howard
(And on subsequent occasions.)

I am writing to refer Mrs HOWARD, a 36-year-old woman, whose signs and symptoms are suggestive of
early bowel obstruction possibly due to diverticulitis or carcinoma, for further management.

Mrs HOWARD is married and has three children. She had undergone ovarian cystectomy and
appendectomy. Moreover, her last menstrual period was occurred in October 2006. On 09/01/07, she
came to emergency with complaints of vaginal bleeding and abdominal cramps possibly because of
spontaneous abortion.

On 20/01/07, Mrs HOWARD reported that she had suddenly onset of pain in the left lower abdomen Commented [ESL2]: had a sudden
yesterday which was relieved by Valium. Unfortunately, the pain still persisted which was sharp as well as
constant and was worsened by sitting up, walking and bending. Upon examination, her left lower Commented [ESL3]: still persisted.
abdominal quadrant was tender and had a vague palpable mess as well. Therefore, pregnancy test, full Commented [ESL4]: she
blood exam and ESR were ordered. On next day, she passed one hard stool coated with bright red blood Commented [ESL5]: a
after 3 days. Commented [ESL6]: the
Commented [ESL7]: reported that she had
On today's review, Mrs HOWARD came complaining of the pain which was now worsening after eating.
Furthermore, she was moderately distressed. Examination revealed tense abdomen and absent bowel
sounds. In addition, her hemoglobin level was 9.3 g/dl. Please note, she passed neither stool nor flatus.
In light of the above, it would be greatly appreciated if you could see this patient for further treatment.

Please do not hesitate to contact me if you have any queries.

Yours sincerely,
Doctor
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