Abdominal/Gastroenterology
A-Lines below the Diaphragm – A Case Report of Occult Pneumoperitoneum
DOI: https://doi.org/10.5070/M5.52389The RUQ POCUS focusing over the left liver lobe shows multiple enhanced peritoneal stripe signs (red arrows) and several reverberation artifacts (yellow arrows). The second RUQ POCUS of the right lobe of the liver and the gallbladder shows reverberation artifacts (yellow arrow) and ring-down artifacts (blue arrow). The chest X-ray shows free air under the right diaphragm (orange arrow), which indicates pneumoperitoneum. The CT abdomen and pelvis show pneumoperitoneum near the porta hepatis (green arrow).
Caught in the Whirl: A Case Report of Midgut Volvulus in an Elderly Patient
DOI: https://doi.org/10.5070/M5.52361An upright chest x-ray demonstrated air underneath the diaphragm bilaterally (yellow arrows), enhancing the diaphragmatic contour. A computed tomography angiography (CTA) abdomen and pelvis showed scattered pneumoperitoneum (red arrow), dilated segments of small bowel (orange arrow), and clockwise swirling of the mesentery (blue arrow), concerning for mesenteric volvulus with possible bowel perforation.
A Case Report of Acute Appendicitis Complicated by Appendicoliths
DOI: https://doi.org/10.5070/M5.52213Contrast-enhanced CT of the abdomen and pelvis was obtained. Coronal CT demonstrated a dilated appendix measuring up to 1.2 cm in diameter with multiple appendicoliths (yellow arrows), the largest measuring 1.1 cm. Mild periappendiceal fat stranding was present, consistent with acute appendicitis complicated by appendicoliths. The surrounding bowel and colon were normal in caliber and distribution. An additional coronal view demonstrated a dilated appendix (yellow arrow) containing an appendicolith with periappendiceal inflammatory changes. No evidence of perforation, abscess, or drainable fluid collection was identified.
Trapped In Transit – A Case Report of a Pediatric Gastric Bezoar Causing Intermittent Small Bowel Obstruction
DOI: https://doi.org/10.5070/M5.52259The CT scan identified a heterogenous, mass-like lesion extending from the gastric fundus to the antrum, along with a small bowel obstruction (SBO) and significant small bowel dilation. An additional smaller heterogenous mass-like lesion was seen in the small bowel, causing the SBO. Given the mass-like lesion’s mixed attenuation and presence of internal air, a gastric bezoar was strongly suspected.
Clinical Decision-Making Case: Intussusception
DOI: https://doi.org/10.21980/J8.52171By the end of this mock oral boards session, learners will (1) demonstrate familiarity with the CDM case format and case play, (2) model a problem-based history and physical exam, (3) generate a differential diagnosis for pediatric abdominal pain, and (4) demonstrate the ability to manage intussusception.
Prioritization: Run This Board: Septic Shock, Acute Coronary Syndrome, Small Bowel Obstruction, and Penetrating Chest Trauma
DOI: https://doi.org/10.21980/J8.52355By the end of this case learners will be able to: 1) Become familiar with format of a prioritization case (a component of the ABEM Certifying Exam), 2) Practice their ability to prioritize multiple patients and provide stabilizing care, 3) Consider changes in status/patient acuity/new cases as presented, 4) Understand how to utilize team resources appropriately.
Abdominal Pain and Vaginal Discharge: An Eye-Opening Simulation Case about Human Trafficking
DOI: https://doi.org/10.21980/J8.52150At the conclusion of this case, learners should be able to: 1) review red flags of identifying victims of human trafficking in healthcare settings, 2) identify common indicators and injuries associated with human trafficking, 3) demonstrate a trauma-informed care approach when interviewing potential victims, 4) list and provide patients with national resources for human trafficking,5) understand federal and state mandatory reporting laws and the role of the healthcare provider, 6) determine best treatment options in patients with limited healthcare access, including counseling on empiric treatment of sexually transmitted infection (STI), 7) review management options for an undesired pregnancy according to local institutional policies and state laws for the senior case.
Case Report of Incarcerated Gastric Volvulus and Splenic Herniation in Undiagnosed Congenital Diaphragmatic Hernia in an Infant
DOI: https://doi.org/10.21980/J8VD27An upper gastrointestinal series (UGI) showed an enteric tube with its tip in the stomach and side-port in the esophagus. There was a large amount of air in the stomach and a small volume of scattered distal bowel gas. The tip of an enteric tube was seen in the stomach (red arrow). Contrast partially filled the stomach, and the greater curvature was visualized superior to the lesser curvature in the left upper quadrant (blue arrow). The body of the stomach was herniated into the right chest through a Bochdalek hernia (blue star). There was a large amount of air in the stomach and a small volume of scattered distal bowel gas. These findings were consistent with mesenteroaxial gastric volvulus.