UMEM Educational Pearls

Title: What's the Diagnosis? Case by Dr. Lindsay Weiner

Posted: 9/14/2016 by Tu Carol Nguyen, DO (Emailed: 9/26/2016) (Updated: 9/26/2016)
Click here to contact Tu Carol Nguyen, DO

Question

22-year-old male with history of autism, mental retardation who is non-verbal presents with abdominal pain and vomiting for one day. Patient was found clutching his abdomen and moaning. What's the diagnosis?

Answer

Small Bowel Obstruction

Presentation: abdominal pain, nausea, vomiting, early diarrhea progressing to lack of flatus or bowel movements with complete obstruction. Severe obstruction can result in perforation, unstable vital signs, and physical exam signs of peritonitis.

Sensitivity and specificity > 90% for diagnosis of SBO with US, with superior test performance compared to X-ray.

US findings: dilated small bowel loops > 3 cm; no peristalsis, swirling snowstorm appearance of bowel contents

Treatment: bowel rest, IV fluids, and prompt surgery consultation! Consider NG tube for decompression.

See the corresponding upright abdominal x-ray, showing dilated bowel with air fluid levels.

References

Kameda T, Taniguchi N. Overview of point-of-care abdominal ultrasound in emergency and critical care. J Intensive Care. 2016 Aug 15;4:53. doi: 10.1186/s40560-016-0175-y. eCollection 2016. Review.

Unl er EE, Yava i O, Ero lu O, Yilmaz C, Akarca FK. Ultrasonography by emergency medicine and radiology residents for the diagnosis of small bowel obstruction. Eur J Emerg Med. 2010 Oct; 17(5):260-4.