A Curious Case of Right Upper Quadrant Abdominal Pain.
An otherwise healthy 36-year-old man presented with sudden-onset right upper quadrant abdominal pain and vomiting. A bedside ultrasound, performed to evaluate hepatobiliary pathology, revealed a normal gallbladder but free intraperitoneal fluid. After an expedited CT and emergent explorative laparotomy, the patient was diagnosed with a small bowel obstruction with ischemia secondary to midgut volvulus. Though midgut volvulus is rare in adults, delays in definitive diagnosis and management can result in bowel necrosis. Importantly, an emergency physician must be able to recognize bedside ultrasound findings associated with acutely dangerous intrabdominal pathology.
Olive View, UCLA Medical Center, Department of Emergency Medicine, Sylmar, California; University of Southern California Medical Center and Keck School of Medicine, Department of Emergency Medicine, Los Angeles, California.
Andrew
A
Grock
SUNY Downstate Medical Center, Department of Emergency Medicine, Brooklyn, New York; Kings County Hospital Department of Emergency Medicine, Brooklyn, New York.
Wendy
W
Chan
SUNY Downstate Medical Center, Department of Emergency Medicine, Brooklyn, New York; Kings County Hospital Department of Emergency Medicine, Brooklyn, New York.
Ian S
IS
deSouza
D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D004065:Digestive System Abnormalities / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery*; D004636:Emergency Service, Hospital; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000000981:diagnostic imaging*; D045822:Intestinal Volvulus / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery*; D007421:Intestine, Small / Q000002:abnormalities* / Q000601:surgery; D008297:Male; D014463:Ultrasonography