Abdominal/Gastroenterology
Vomiting in Pediatric Patients
DOI: https://doi.org/10.21980/J8P363By the end of this TBL session, learners should be able to: 1) Identify red flag symptoms that should prompt referral for urgent intervention by GI or surgical specialists; 2) recognize how chronicity of the vomiting can alter the differential diagnosis; 3) describe the varying pathways that can cause nausea and vomiting; 4) determine the necessity of imaging tests to confirm and possibly treat various causes of vomiting; 5) interpret imaging studies associated with specific causes of vomiting.
A Case Report of Ogilvie’s Syndrome in a 58-year-old Quadriplegic
DOI: https://doi.org/10.21980/J82922Plain radiograph of the patient's abdomen revealed a gaseous distention of the colon. This is demonstrated as noted in the abdominal x-ray as gaseous distention, most notably in the large bowel (arrows) including the rectal region (large circle). Follow up computed tomography (CT) scan affirmed severe pancolonic gaseous distention measuring up to 11.2 cm, compatible with colonic pseudo-obstruction as noted by the large red arrows. No anatomical lesion or mechanical obstruction was observed, as well as no evidence of malignancy or other acute process.
Cecal Volvulus Diagnosed with a Whirl Sign: A Case Report
DOI: https://doi.org/10.21980/J8XM05The CT image demonstrates a “whirl sign” (red arrow) which is indicative of a volvulus. This image occurs when bowel, mesentery and vasculature rotate around a transition point causing an image similar to a hurricane on a weather map. When seen on a CT scan, a whirl sign suggests a high likelihood of either a closed loop bowel obstruction or volvulus in the cecum, sigmoid or midgut. In any of the cases, seeing a whirl sign strongly increases the need for emergent surgical management.
Is an X-ray a Useful Test for Esophageal Food Boluses? A Case Report
DOI: https://doi.org/10.21980/J8Q639The plain film radiograph of the chest demonstrated a fluid level (yellow arrow) in the distal esophagus with dilation of the esophagus proximal to that point (blue line). Neither of these findings were present on the previous visit.
Loose PEG Tube Leading to Peristomal Leakage and Peritonitis
DOI: https://doi.org/10.21980/J8HS7TFrontal chest X-ray showed a large radiolucent area (pink highlighted area) underneath the diaphragm (yellow line) and on top of the liver (blue highlighted area) and spleen (green highlighted area) suggestive of pneumoperitoneum possibly caused by gastrointestinal perforation. This large radiolucent area can also be seen underneath the diaphragm in the lateral view chest X-ray. Computed tomography (CT) was not performed due to his physical exam findings and the significant positive findings on chest X-ray. Surgery was consulted and patient was taken emergently to the operating room.
Hemorrhagic Renal Cyst
DOI: https://doi.org/10.21980/J8C92VBedside renal ultrasound demonstrated a right renal cyst with echogenic debris consistent with a hemorrhagic cyst (red arrow). In addition, a computed tomography (CT) scan of the abdomen and pelvis revealed a 4mm non-obstructing right renal stone and bilateral renal cysts. The CT also confirmed the ultrasound finding of a right renal cyst with mild perinephric stranding possibly consistent with a hemorrhagic cyst.
Meckel’s Diverticulum Causing Small Bowel Intussusception in Third Trimester Pregnancy
DOI: https://doi.org/10.21980/J87H19A CT scan was obtained which demonstrated distal small bowel intussusception with focal dilation suggestive of a small bowel obstruction in a pregnant female in her third trimester of pregnancy. The fetus can be seen in the uterus. The yellow arrow identifies the area of small bowel intussusception shown by telescoping intestines with associated bowel wall edema.
Bilateral Common Iliac Artery Aneurysm
DOI: https://doi.org/10.21980/J83S73A bedside ultrasound of the aorta was performed. The proximal, middle, and distal aorta appeared normal in caliber, as demonstrated by the images; however there seemed to be some enlargement at the bifurcation. The bifurcation into the iliac arteries, as highlighted by the yellow arrow, demonstrates a slightly enlarged iliac artery on the left. The aorta was followed below the bifurcation as it divided into the iliac arteries, as shown in the video clip. The ultrasound demonstrated a left iliac artery aneurysm measuring 5.99 cm, as highlighted by the orange circle. There were aneurysms to the bilateral common and internal iliac arteries.
Incarcerated Ventral Hernia of T-colon Resulting in Colon Perforation and Intraabdominal Abscess
DOI: https://doi.org/10.21980/J83W74History of present illness: A 75-year-old female with a remote history of rectal cancer presented to the emergency department with acute right upper abdominal pain. The pain had begun suddenly after lunch. On review of systems, the patient had mild nausea. Initial vital signs were within normal limit. She denied fever, chills, or vomiting. The physical examination revealed a distended,
Bezoars: An Interesting Case of Abdominal Pain
DOI: https://doi.org/10.21980/J8VD1VComputed tomography (CT) of the abdomen and pelvis with oral and intravenous contrast was ordered to evaluate her symptoms. The CT showed three large collections of ingested material seen as hypodense material with circular rings surrounded by the hyperdense oral contrast (see red outlines). These findings are consistent with bezoars, the largest of which measured 11.5 x 7.8 cm. There was also thickening of the gastric wall (see blue outline), most notably at the pylorus, consistent with partial obstruction.