Abdominal/Gastroenterology

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Ventriculoperitoneal Shunt Migration

Justin P Puller, MD* and Jonathan T Miller, MD*

DOI: https://doi.org/10.21980/J8G019Issue 2:1 No ratings yet.
An immediate post-op abdominal x-ray performed after the patient’s VP shunt revision 30 days prior to this ED visit reveals the VP shunt tip in the mid abdomen. A CT of the abdomen performed on the day of the ED visit reveals the VP shunt tip interposed between the spleen and the diaphragm.
Abdominal/GastroenterologyVisual EM
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Computed Tomography Diagnosis of Appendicitis

Christopher Libby, MPH* and Shannon Toohey, MD, MAEd^

DOI: https://doi.org/10.21980/J8F30NIssue 2:1 No ratings yet.
The CT abdomen/pelvis with IV contrast shows a dilated appendix (see red outline) with thickened, hyperenhancing wall (see blue outline) best visualized in the axial and coronal planes.
Abdominal/GastroenterologyVisual EM
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Gastric Bezoar

Samer Assaf MD*

DOI: https://doi.org/10.21980/J85K5WIssue 2:1 No ratings yet.
In the abdominal radiograph, a nonspecific and non-obstructive bowel gas pattern with no air-fluid level was noted, however the stomach was distended with soft tissue. The CT abdomen/pelvis revealed a distended stomach with undigested heterogeneous contents (presumed bezoar).
Abdominal/GastroenterologyVisual EM
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Cholelithiasis: WES Sign

Hamid Ehsani-Nia, MS* and Shannon Toohey, MD, MAEd^

DOI: https://doi.org/10.21980/J8X300Issue 2:1 No ratings yet.
Abdominal ultrasound showed the classic presentation of the Wall-Echo-Shadow (WES) sign. The superficial aspect of the gallbladder wall is represented by a hyperechogenic curve. Below this, bile fluid is represented by hypoechogenicity. Underneath the bile fluid is the echo of the dense border created by the collection of gallstones, represented by a hyperechogenic curve. Due to the high density of the gallstones, nothing deeper can be visualized (including other gallstones or the far end of the gallbladder); this is the shadow.
Abdominal/GastroenterologyUltrasoundVisual EM
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Perforated Duodenal Ulcer

Jessa Baker*, Jonathan Patane, MD* and Carrie Chandwani, MD*

DOI: https://doi.org/10.21980/J8TG64Issue 1:2 No ratings yet.
In the chest radiograph, there was obvious free air under the both the right diaphragm (above the liver) and the left diaphragm, consistent with pneumoperitoneum.
Abdominal/GastroenterologyVisual EM

Mesenteric Ischemia

Shannon Toohey, MD*

DOI: https://doi.org/10.21980/J8CC7FIssue 1:1 No ratings yet.
At the end of this simulation session, the learner will: 1) Recognize signs and symptoms of mesenteric ischemia; 2) order appropriately imaging and labs in the workup of an elderly patient with abdominal pain; 3) manage a patient with mesenteric ischemia, a rare, but serious cause of abdominal pain in the elderly; 4) discuss anchoring bias, specifically related to patients referred to the ED with an established diagnosis by outside specialists.
Abdominal/GastroenterologySimulation