Tuesday, January 29, 2013

Methodist ED: Real Clinical Cases Series PART 1

42 yo F minimally verbal at baseline (s/p CVA?) brought from NH for distended abdomen and low grade fever. Only surgical history appears to be scar from prior PEG tube in LUQ.

PE:  Vital: Tachycardic 100-120,  Rectal 101 F. Otherwise WNL.

Alert, moaning, nonverbal. Moaning loud with bed movement. Anicteric.
Cardiopulm: Tachycardic, Lungs CTAB
Skin: Vitiligo
Abdomen: Severe abdominal distension. No bowel sounds heard. Apparent rebound TTP. Rigid.

Bedside US of abdomen


Bedside Upright Chest/Abdomen Xray.


CT w/o Contrast

Case Conclusion:   CT revealed sigmoid volvulus. Pt was taken emergently to OR where GI reduced the volvulus without complication using rigid sigmoidoscopy and insufflation. The next day the patient had an elective sigmoidectomy to remove redundant colon. 

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