Abdominal/Gastroenterology

Creative Commons images

Bowel Perforation complicating an incarcerated inguinal hernia

Adam Sigal, MD* and Jamie Slotkin, DO^

DOI: https://doi.org/10.21980/J8D30BIssue 2:2[mrp_rating_result]
The AP and lateral pelvis x-rays revealed two sewing needles, 60 mm in length, within the soft tissue over the anterior right lower hemipelvis. In addition, the AP view showed emphysema involving the right hemiscrotum (arrow), concerning for perforated bowel.
Abdominal/GastroenterologyVisual EM
Creative Commons images

A Toddler with Abdominal Pain and Emesis

Saema Said, BS* and Kevin Koenig, MD*

DOI: https://doi.org/10.21980/J8XW2P Issue 2:2[mrp_rating_result]
In the long axis video, the appendix appears as an enlarged, non-compressible, blind-ending tubular structure (white arrow) with distinct appendiceal wall layers and lack of peristalsis. In the short axis video, the appendix appears as a target sign (yellow arrow) between the abdominal and psoas muscles. The maximal outer diameter (MOD) measures 11.8mm and the appendix wall measures 0.17mm. There is trace adjacent free fluid and echogenic periappendiceal fat. Transverse axis video and image (red arrow) demonstrate that the appendix is not compressible. These findings are consistent with acute appendicitis.
Abdominal/GastroenterologyInfectious DiseasePediatricsUltrasoundVisual EM

Novel Emergency Medicine Curriculum Utilizing Self-Directed Learning and the Flipped Classroom Method: Gastrointestinal Emergencies Small Group Module

Andrew King, MD, FACEP*, Elizabeth Matheson^, BS, Christopher San Miguel, MD*, Sarah Greenberger, MD*, Michael Barrie, MD*, Jillian McGrath, MD*, Howard Werman, MD*, Ashish Panchal, MD*, Daniel Martin, MD*, David P Bahner, MD*, Sorabh Khandelwal, MD* and Jennifer Mitzman, MD*

DOI: https://doi.org/10.21980/J8MS37 Issue 2:1[mrp_rating_result]
We aim to teach the presentation and management of GI emergencies through the creation of a flipped classroom design. This unique, innovative curriculum utilizes resources chosen by education faculty and resident learners, study questions, real-life experiences, and small group discussions in place of traditional lectures. In doing so, a goal of the curriculum is to encourage self-directed learning, improve understanding and knowledge retention, and improve the educational experience of our residents.
Abdominal/GastroenterologyCurriculaSmall Group Learning
Creative Commons images

Ventriculoperitoneal Shunt Migration

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

DOI: https://doi.org/10.21980/J8G019Issue 2:1[mrp_rating_result]
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
Creative Commons images

Computed Tomography Diagnosis of Appendicitis

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

DOI: https://doi.org/10.21980/J8F30NIssue 2:1[mrp_rating_result]
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
Creative Commons images

Gastric Bezoar

Samer Assaf MD*

DOI: https://doi.org/10.21980/J85K5WIssue 2:1[mrp_rating_result]
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
Creative Commons images

Cholelithiasis: WES Sign

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

DOI: https://doi.org/10.21980/J8X300Issue 2:1[mrp_rating_result]
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
Creative Commons images

Perforated Duodenal Ulcer

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

DOI: https://doi.org/10.21980/J8TG64Issue 1:2[mrp_rating_result]
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