Abdominal/Gastroenterology

Sigmoid Diverticulitis Complicated by Colovesical Fistula Presenting with Pneumaturia

Faraz Khan, BS^*, Justin Yanuck, MD^* and C Eric McCoy, MD, MPH^*

DOI: https://doi.org/10.21980/J80G9TIssue 4:2 No ratings yet.

A CT scan of his abdomen/pelvis shows acute sigmoid colonic diverticulitis with adjacent extraluminal collection containing gas (axial view, white arrow) consistent with perforation, along with abutment of the urinary bladder with intraluminal bladder gas (sagittal and coronal views, white arrowheads) suggesting colovesical fistula.

Abdominal/Gastroenterology Visual EM

Brief Review of Intussusception Diagnosis and Management

Claire Thomas, MD^*, Wirachin Hoonpongsimanont, MD^*, Sara Paradise, MD^* and Mohammad Helmy, MD^{^}

DOI: https://doi.org/10.21980/J81P7FIssue 3:4 No ratings yet.

The patient’s abdominal ultrasound revealed intussusception in the right upper abdominal quadrant. The transverse ultrasound view showed a “doughnut sign” (dashed yellow line), telescoping bowel (yellow arrow), and invaginated hyperechoic mesenteric fat with crescent configuration (dashed orange line). The sagittal ultrasound view demonstrated the intussusception formed by the outer recipient bowel loop (yellow arrows), invaginated hyperechoic mesenteric fat (orange asterisks), and telescoping bowel centrally (red arrow).

Abdominal/Gastroenterology Pediatrics Visual EM

Realistic and Inexpensive Ultrasound Guided Paracentesis Simulator Using Pork Belly with Skin

Jonathan Kei, MD, MPH^* and Donald P Mebust, MD^*

DOI: https://doi.org/10.21980/J8NK9RIssue 3:3 No ratings yet.

By the end of this instructional session learners should be able to: 1) Discuss the indications, contraindications, and complications associated with abdominal paracentesis; and 2) competently perform an ultrasound-guided abdominal paracentesis on a simulator and remove fluid.

Abdominal/Gastroenterology Innovations Procedures

Recurrent Sigmoid Volvulus in a Young Female

Ahmed Farhat, BS^* and Robert Rowe, MD^*

DOI: https://doi.org/10.21980/J8GW5SIssue 3:3 No ratings yet.

Computed tomography (CT) of the abdomen and pelvis was obtained revealing a colonic volvulus in the left mid to upper abdomen (blue arrow) involving the distal transverse colon and descending colon, with gaseous colonic distention to 8.5 cm (red arrow). The characteristic “whirl pattern” is also present (yellow arrow). These findings are suggestive of a high-grade colonic obstruction. It was without evidence of pneumoperitoneum, pneumatosis, or drainable collection. Of note, a 3.6 cm dermoid tumor is also observable in the left adnexa (green arrow).

Abdominal/Gastroenterology Visual EM

Acute Dysphagia in a 25-Year-Old Male

Michael Ullo, MD^*, Robert Joshua Dym, MD^{^} and Jill Ripper, MD^*

DOI: https://doi.org/10.21980/J83P8FIssue 3:3 No ratings yet.

After an unremarkable chest radiograph was obtained, a computed tomography (CT) scan of the chest was obtained due to possible co-ingestion of bones to rule out perforation. The CT scan demonstrated focal distention of the mid-esophagus due to an impacted food bolus (white arrow). An aberrant right subclavian artery (yellow arrow) was located just distal to the impaction site with partial compression of the esophagus (red arrow).

Abdominal/Gastroenterology Visual EM

Woman Swallows a “Handful of Pills”

Sarah E Mott, MD^*, Michael Paddock, DO, MS^{*^} and Jessie Nelson, MD^{*^}

DOI: https://doi.org/10.21980/J8V64XIssue 3:3 No ratings yet.

Soft tissue lateral X-ray of neck was performed. The lateral soft tissue X-ray of the neck showed a metallic foreign body at the level cricoid.

Abdominal/Gastroenterology Visual EM

Incidental Hiatal Hernia on Chest X-ray

Ahmed Farhat, BS^* and Daryn Towle, MD^*

DOI: https://doi.org/10.21980/J8KP8SIssue 3:3 No ratings yet.

The two-view chest X-ray shows mild opacification of the bilateral lower lobes concerning for pneumonia (red arrows). Incidental retrocardiac opacity with air-fluid level consistent with large hiatal hernia is also observed (green arrow).

Abdominal/Gastroenterology Visual EM

Button Battery in Esophagus

Sha Yan, DO^* and Ernest Leva, MD^*

DOI: https://doi.org/10.21980/J8FW6VIssue 3:3 No ratings yet.

Chest radiograph showed the presence of a round radiopaque foreign body in the mid-chest. It was suspected to be in the esophagus rather than in the trachea due to the en-face positioning of the foreign body. The foreign body demonstrated two concentric ring circles concerning for a “double ring” or “halo" sign, which was suggestive of the presence of a button battery rather than a coin.

Abdominal/Gastroenterology Visual EM

Achalasia: An Uncommon Presentation with Classic Imaging

Joseph Adamson, BS^*, Mina Altwail, MD^{^} and Shanna Jones, MD^{^}

DOI: https://doi.org/10.21980/J86D2BIssue 3:3 No ratings yet.

The chest X-ray demonstrated a markedly widened mediastinum (red brackets), raising concern for thoracic aortic aneurysm/aortic dissection, which prompted labs and contrast-enhanced computed tomography (CT) of the chest. The CT revealed a dilated proximal esophagus that narrowed distally (yellow tracing and red arrow), with particulate material, mass-effect on the trachea (purple outline), and bilateral patchy opacities suggesting aspiration. Barium esophagram showed a drastically dilated esophagus filled with contrast (yellow arrow), terminating into the classic “bird’s beak sign” (red arrow) at the lower esophageal sphincter (LES). Esophageal manometry later confirmed achalasia, proving that widened mediastina can have unexpected etiologies.

Abdominal/Gastroenterology Visual EM

Point of Care Ultrasound Illustrating Small Bowel Obstruction

Badriah Alruwaili, MBBS^* and Shadi Lahham, MD^*

DOI: https://doi.org/10.21980/J8T637Issue 3:3 No ratings yet.

POCUS of the small bowel illustrated significantly dilated loops of bowel (white line), thickened bowel wall (white arrow) and to-and-fro peristalsis, consistent with small bowel obstruction.

Abdominal/Gastroenterology Ultrasound Visual EM