Cause Of Acute Abdominal Pain Research Articles

S2029 Epiploic Appendagitis: A Red Herring?

Introduction: Epiploic appendagitis (EA) is a rare cause of acute abdominal pain that has a relatively benign course. The importance of identifying EA as a clinical mimicker is crucial to avoid unnecessary hospitalizations, antibiotic use, and surgery. Although no trigger has been established as a cause for EA, it is hypothesized that systemic inflammation can lead to an EA attack. Case Description/Methods: A 43-year-old White female with no significant GI history presented with 2 days of sudden onset, sharp, non-radiating, worsening left lower quadrant (LLQ) with nausea. Initial blood work was unremarkable. CT abdomen revealed a hyper-attenuating ring lesion along the anti-mesenteric margin adjacent to the distal descending colon, along with mesenteric lymph nodes consistent with epiploic appendagitis. She was managed conservatively with complete resolution of symptoms. A few years later, she presented again, with similar abdominal complaints. Repeat abdominal imaging showed recurrence of EA in the same location. Few shotty mesenteric lymph nodes were identified. She was treated conservatively for EA. A few more years passed, and she now had another episode of recurrent LLQ pain, CT abdomen showed findings consistent with EA along with a short segment of mural thickening and mild hyper-enhancement in the mid descending colon. Colonoscopy revealed a large circumferential mass in the sigmoid colon with an apple core lesion in the proximal sigmoid colon with luminal narrowing. Biopsy revealed an adenocarcinoma. No lymph node involvement was noted. As the TNM staging was pT3 N0 M0, she underwent a sigmoidectomy with left colon and rectal end-to-end anastomosis (Figure). Discussion: Epiploic appendages are fat-filled serosal outpouchings of the colonic surface. They are connected to the colon by a vascular stalk. Acute epiploic appendagitis is theorized to be caused by torsion, underlying inflammation, or venous occlusion of the appendage. CT scan is the gold standard for diagnosing EA and helps rule out other intra-abdominal pathologies. Recurrent and persistent EA is very rare and may mask an underlying occult abdominal pathology. There have not been any reported cases of CRC that are associated with and possibly trigger EA. In patients with recurrent EA, after common causes of acute abdominal pain are ruled out, evaluation for intestinal/intraluminal pathologies, especially colorectal malignancy should be considered as they are not readily apparent on CT scans.Figure 1.: A: Red arrow showing an inflamed epiploic appendage during initial presentations. B: Red arrow showing epiploic appendagitis. Green arrow with colonic wall thickening in the descending colon, with adjacent EA. 3: Colonoscopy showing the large friable mass in the sigmoid colon.

Appendicitis Inflammatory Response Score in Acute Appendicitis: A Study at a Tertiary Care Center in North India.

Appendicitis is a common cause of acute abdominal pain. The diagnosis is eminently clinical and the cause is surgically correctable. However, a decision of surgery based on the clinical presentation only has a 15%-30% chance of the removal of a normal appendix. Thus, the diagnosis involves a corroboration of clinical, laboratory, and radiological findings. Appendicitis scoring systems can be considered to expedite the diagnostic and decision-making process. The present study was conducted to study the efficacy of Appendicitis Inflammatory Response (AIR) score in the diagnosis of acute appendicitis and its correlation with the histopathological findings. A cross-sectional study was conducted at a tertiary care center in North India comprising patients who presented to the surgery department with a provisional diagnosis of acute appendicitis and required appendectomy. Appendicitis was histopathologically proven in 54 patients. Patients with an AIR score ≥5 were 2.18 times more likely to have appendicitis. The probability of having appendicitis with AIR score ≥5 was 92.16% (positive predictive value). The diagnostic accuracy of AIR score was 82.81%. AIR score has a high sensitivity and positive predictive value in the diagnosis of acute appendicitis. It is a quick and convenient system for clinical evaluation of patients in primary care or peripheral hospitals where advanced facilities such as USG scan or CT scan are not available all the time. The application of this scoring system definitely improves diagnostic accuracy and reduces negative appendectomy rate.

Traditional Chinese Medicine Decoction for Acute Pancreatitis in Elderly Patients: A Protocol for Systematic Review and Network Meta-analysis

Background Acute pancreatitis is the most common disease of the pancreas, and is a common cause of acute abdominal pain. Elderly patients with acute pancreatitis are more likely to develop complications,and they experience substantially higher mortality than the middle-aged patients. Although many studies have shown that traditional Chinese medicine are effective for the treatment of acute pancreatitis, the efficacy and safety of different traditional Chinese medicine decoctions for acute pancreatitis in elderly patients are not fully clarified. In addition, because many traditional Chinese medicine decoctions are available for the pancreatitis, the selection of an appropriate decoction has become a pressing issue. This study aimed to compare the effectiveness of different traditional Chinese medicine decoction for elderly patients with acute pancreatitis by using network meta-analysis. Methods Random clinical studies on traditional Chinese medicine decoction for acute pancreatitis will be searched using the following databases: PubMed, Cochrane Library, Web of Science, Embase, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Wan Fang Database, VIP Database for Chinese Technical Periodicals, Medline, and Clinical Trial Register, from their inception to June 2022. Network meta-analyses will be performed to examine the efficacy of different traditional Chinese medicine decoction in the treatment of acute pancreatitis. Results This study will evaluate the effectiveness of different traditional Chinese medicine decoction in elderly patients with acute pancreatitis. Conclusion Results from this study may contribute to provide evidence for selecting an appropriate traditional Chinese medicine decoction for elderly patients with acute pancreatitis.

WE5.9 Management of acute abdominal pain in children at District General Hospital (DGH)

Abstract Introduction Children with acute abdominal pain are frequently seen in paediatric A&E at DGH. Acute appendicitis is the most common surgical cause of acute abdominal pain in children. Diagnosis and management can be a problem in the absence of paediatric surgical unit Methods A retrospective study was conducted at a busy DGH where general surgical department is routinely involved in the management of acute abdominal pain in children. 6 months data was collected from 01/06/21 to 30/11/21. Results 381 patients (5–16 years) attended paediatric emergency with complaint of abdominal pain. 24% referred to surgeons (females 53%, mean age 10.9 years). All Presented with pain in RIF, migratory pain was in 42%. Nausea and vomiting were reported in 38%, loose stools in 10.8% and loss of appetite in 21.7%. Duration of pain vary between 24 hours to 3 weeks. WCC was raised in 32% patients, US was performed in 21.7%, CT scan in 5.4%, MRI 1%, and 1% had both Ultrasound and MRI. 46.7% did not have any radiological investigations. Appendectomy was performed in 21% (19) patients including laparoscopic in two. Duration of stay range from less than 24 hours to 5 days. 46.7% were discharged within 24 hrs of review, 21.7% stayed for one and only 2% stayed for five days. 1 patient was readmitted following a post operative collection that was managed conservatively. 2 referred to tertiary paediatric unit for complicated appendicitis. Conclusion This data proves that paediatric patients with suspected appendicitis can be safely managed in a surgical unit at DGH.

ANALYSIS OF ACUTE APPENDICITIS CLINICAL PATHWAYS IMPLEMENTATION IN ROYAL PRIMA MEDAN GENERAL HOSPITAL YEAR 2020

Introdution: Clinical pathway (CP) is a disease management tool used to reduce unnecessary variations in services, increase clinical outcomes, and control resources. Acute appendicitis is one cause of acute abdominal pain, where cases of appendix perforation range from 20-30% increasing to 32-72% at the age of more than 60. Methods: This research was conducted using mix method with case study design. Qualitative data were taken by interview and observation. Quantitative data were taken with a simple description from the acute appendicitis CP documentation in medical records and ICPAT (January - September 2020, n = 117). Result: According to the result of the research, the level of completeness for CP was 100% and form filling was 85%. Conclusion: ICPAT dimension 1 made sure that the form was the clinical pathway. The content and quality were good, and dimension 2 assesses the CP documentation process. The content is lacking and the quality is moderate, dimension 3 assess the CP development process which content was good, and quality was moderate, and dimension 4 assesses the CP implementation process. The content was moderate, and the quality was good. Dimension 5 is to assess the maintenance of clinical pathways in which content was lacking and quality was moderate. Dimension 6 serves to assess the role of the organization that content was good and quality was moderate where the obstacles were due to lack of understanding and time constraints.

Omental torsion mimicking acute appendicitis in a 7-year-old boy: a case report

BackgroundTorsion of the greater omentum is an uncommon cause of acute abdominal pain. Omental torsion can be divided into primary and secondary. Owing to its nonspecific abdominal pain, preoperative diagnosis is difficult. Ultrasound sonography and abdominal computed tomography scans do not have a major role in preoperative diagnosis. The definite diagnosis is usually made during operation.Case presentationA 7-year-old Persian boy was referred with right lower quadrant pain associated with nausea and vomiting. Laboratory blood tests and urinalysis were requested that revealed normal values. Ultrasonography was performed, revealing inflammatory changes with mild free fluid collection in the interloop. The patient underwent an open appendectomy, confirming a normal appendix with omental torsion. Two days later, he was discharged home without postoperative complications.ConclusionsIn patients with acute abdomen, particularly those with acute appendicitis symptoms, omental torsion should be considered in the differential diagnosis.

Non-obstetric causes and presentations of acute abdominal pain among pregnant women

Objectives: Assess the patient characteristics and presentations of non-obstetric causes of acute abdominal pain among pregnant women.
 Methods: Sixty five pregnant patients of different gestational age groups were enrolled in this study who visited Sulaimani Emergency Hospital between 2nd January 2019 and 31 December 2019. 
 Results: Acute appendicitis is the most common cause of non-obstetric abdominal pain in pregnant women (35.4%) followed by acute cholecystitis (18.5%) and renal stones (12.3%). Miscarriages are most commonly associated with acute pancreatitis with a rate of (50%). The majority of the patients were discharged home well within one month except for one patient (1.5%) who unfortunately died after surgical treatment for acute appendicitis.
 Conclusion: Acute appendicitis is the most common non-obstetric cause of acute abdominal pain in pregnant women. While 2nd and 3rd causes were, acute cholecystitis and renal colic consecutively in decreasing frequency.

Gastroduodenal Perforation in a Child With Sickle Cell Anemia: A Case Report

Objectives: Gastroduodenal perforation (GDP) is a rare cause of acute abdominal pain in children. Case Presentation: A 12-year-old boy presented with abdominal pain around the periumbilical and epigastric region on 7previous days. His familial history was significant for sickle cell anemia in the mother and minor thalassemia in the father. He had been diagnosed with sickle cell anemia at the age of 4 years and had received blood transfusion and hydroxyurea every month. At physical examination, a distended abdomen and decreased intestinal sounds were seen. Also, he had a history of cholecystectomy (for cholelithiasis). Fecal occult blood was detected, while no Helicobacter pylori antigen was present. Abdominal ultrasound examination revealed splenomegaly and evidence of free fluid. Surgical results showed bile discharge in the abdominal cavity, and perforation of duodenum and pylorus. Conclusions: Since the symptoms of GDP in children are non-specific, especially in children with sickle cell anemia, it should be considered in these patients with abdominal pain.

Omental infarction, unusual cause of abdominal pain

Omental infarction describes ischemic torsion of the distal portion of the omentum and constitutes an infrequent cause of acute abdominal pain in childhood of which few cases are known. Objec tive: To analyze through a clinical case the characteristics and management of this pathology, to consider this entity in the differential diagnosis of acute abdominal pain. An 11-year- old child consulted the emergency department due to a 48-hour history of continuous abdominal pain, which had progressively increased. On the physical examination, the patient presented pain in the right side of the abdomen and the epigastric area, with no signs of peritoneal irritation, and was overweight (BMI 91st percentile). Biochemical analysis showed a slight increase in c-reactive protein (CRP) 41.31 mg/L (reference value < 3.0 mg/L) without leukocytosis and normal ultrasound study, without visualization of the appendix. Due to persistent pain, increased CRP, and absence of appen dix visualization in the ultrasound, the study was completed with an abdomen and pelvis CT scan which showed trabeculation of the fat of the anterior right subhepatic space, thus diagnosing omental infarction. The patient was hospitalized for conservative management with analgesia, anti-inflamma tory drugs, and fluid therapy, presenting good evolution in the first 48 hours. Omental infarction is an infrequent cause of acute abdominal pain in childhood. Imaging studies play a funda mental role in the differential diagnosis of this entity with other clinical conditions of similar course, thus avoiding unnecessary surgical interventions.

Clinical profile of patients presenting with thiamine-responsive upper-gastrointestinal upset: A pointer toward gastric beriberi

ObjectivesAlthough beriberi is considered a forgotten disease in the West, Kashmir has a rice-eating population that has beriberi in endemic proportions. Patients with a thiamine deficiency (TD) occasionally present with gastrointestinal (GI) symptoms, including nausea, recurrent vomiting, loss of appetite, and abdominal discomfort. Together these often respond to thiamine, which points to gastric beriberi. MethodsPatients with GI symptoms suggestive of TD were recruited from the Department of Medicine at the Government Medical College and its associated hospital, SMHS, in Srinagar, India. Patients were evaluated for serum thiamine levels, serum lactate, biochemical parameters, and transabdominal ultrasonography after ruling out the usual causes of acute abdominal pain and vomiting. ResultsA total of 27 patients were recruited with a mean age of 47.28 ± 20.84 y. The mean lactate of patients at the time of admission was 6.43 ± 5.22 mmol/L, and the mean lactate at the time of discharge was 1.23 ± 0.50 mmol/L. All patients had a history of consuming polished rice, washed two to three times before cooking, as the staple diet. The most common GI symptoms were recurrent vomiting, nausea, and loss of appetite. All of the patients responded to the thiamine treatment, and showed improvement in their GI symptoms and decreased serum lactate levels within 2 to 6 h of their hospital stay. ConclusionsGastric beriberi is a rare presentation of TD that can lead to severe GI symptoms and lactic acidosis. Given the rapid response to thiamine, it is the standard-of-care treatment in such cases. Thus, clinicians should suspect TD when patients present with either mild or moderate-to-severe GI symptoms and raised blood lactate.

Hypertriglyceridaemia in adolescents may have serious complications

Acute pancreatitis is an often-overlooked cause of acute abdominal pain in children and adolescents. Severe hypertriglyceridaemia is an important cause of recurrent acute pancreatitis. Monogenic causes of hypertriglyceridaemia, such as familial chylomicronaemia caused by lipoprotein lipase deficiency, are more frequently encountered in children and adolescents, but remain rare. Polygenic hypertriglyceridaemia is more common, but may require a precipitant before manifesting. With the global increase in obesity and type 2 diabetes, secondary causes of hypertriglyceridaemia in children and adolescents are increasing. We report two cases of severe hypertriglyceridaemia and pancreatitis in adolescent females. Hypertriglyceridaemia improved markedly with restriction of dietary fat. An inhibitor to lipoprotein lipase was found to be the cause in one patient, while in the other limited genetic investigation excluded chylomicronaemia owing to deficiency of lipoprotein lipase, its activators and processing proteins.

Biochemical and Radiological Parameters in Acute Pancreatitis among Patients from a Rural Community of South India

Background and Purpose: Acute pancreatitis is one of the major causes of acute abdominal pain that requires hospital admission worldwide. Our objective was to find the proportion of acute pancreatitis in acute abdomen cases among the rural population and to assess pancreatic enzymes (lipase and amylase) for the severity of acute pancreatitis. By doing so, we can establish the importance of a single enzymatic marker in acute pancreatitis. Methods: A retrospective and observational study was undertaken on men and women of all age groups admitted over 1 year with acute pancreatitis at a rural tertiary care hospital located at the tristate junction of South India. Pancreatic enzymes (lipase and amylase) were compared based on the grading and severity of pancreatitis according to the modified computed tomography severity index. Results: The proportion of acute pancreatitis was 40% among all acute abdomen cases. Most patients with acute pancreatitis were chronic alcoholic men (62.5%). The common finding in abdominal ultrasonography (USG) was the enlargement of the pancreas (97.5%). There was an overall rise in serum lipase levels in all acute pancreatitis patients, especially in alcoholic patients. The median lipase levels were higher in severe acute pancreatitis than in moderate acute pancreatitis, with P = 0.006. In comparison, there was no significant difference in amylase values between them. Conclusions: In this study, we could conclude that acute pancreatitis is one of the major emergency conditions in this region of rural India, especially among men who are chronic alcoholics. The enlargement of the pancreas was the most frequent finding in USG among these patients. We suggest that a single pancreatic marker (serum lipase) in acute pancreatitis can be cost-effective. Moreover, serum lipase can also be a marker for assessing the severity of acute pancreatitis.

Determine the Accuracy &amp; Use of Ultrasound Guidance and Alvarado Score for Diagnosing Acute Appendicitis

Background: Appendicitis is one of the most common and frequently encountered operations in surgical emergencies. It is the most frequent cause of acute abdominal pain. Early and accurate diagnosis can reduce the rate of negative appendectomy (surgical removal of appendix) and helps to provide better treatment with no extra cost and complications. Aim: The objective of this study was to examine the accuracy and use of ultrasonography and Alvarado score system for diagnosing Acute Appendicitis. Place and Duration of Study: Radiology Department Hayatabad Medical Complex, Peshawarfor duration of six months from January 2021 to June 2021. Methods: In this cross-sectional observational study, 130 patients of abdominal pain having ages of 10 years to 70 years were included. All patients had diagnosis with Alvarado scoring system and ultrasound for identifying Acute Appendicitis. Patients’ detailed history including age, sex and histopathology and ultrasonographic results were recorded. All statistically data was analyzed by SPSS version 17. P-value &lt;0.05 was considered as significant. Results: Out of 130 patients, 95 (73.08%) patients were men and 35 (26.92%) patients were women. 15 (11.54%) patients were ages less than 20 years, 75 (57.70%) patients having ages between 20 to 39 years, 32 (24.62%) patients were aged between 40 to 59 years and 8 (6.15%) patients were ages of &gt;59 years. Symptoms observed in all patients such as anorexia, nausea and vomiting, tenderness in right iliac fossa, rebound tenderness, elevated temperature as 71.54%, 53.85%, 100%, 95.39% and 84.62% respectively. In all 130 patients 122 (93.85%) had found acute appendicitis by using ultrasound. As per histopathology results 95 % had acute appendicitis and 5 % had chronic or normal appendicitis. Conclusion: It is concluded that Alvarado Score system along with noninvasive ultrasound guidance resulted accurately and helps to reduce the rate of negative appendectomy, complications and infections with no extra cost. The combine role of Alvarado score and ultrasonography can helps to provide better treatment in acute appendicitis. Keywords: Alvarado score system, Histopathology findings, ultrasound results, Appendicitis.

MR Imaging of Abdominal Pain in Pregnant Women: A Review of Common Obstetric and Non-Obstetric Pathologies

Acute abdominal pain in pregnancy is a common presenting symptom in the emergency setting, often requiring a quick imaging diagnosis to exclude etiologies associated with high maternal and fetal morbidity/mortality and guide proper patient management. Although US is the first-line imaging modality, many of the common causes of acute abdominal pain in pregnancy are not readily diagnosed sonographically.

Clinico-pathological Profile and Immediate Hospital Outcome of Acute Pancreatitis

Background: Acute pancreatitis (AP) is a significant cause of acute abdominal pain, morbidity andhospitalization. Knowing the details of the clinico-pathological presentation and outcome of the diseasemay aid the better understanding of the disease.Objective: The study was designed to assess the clinico-pathological profile and to estimate immediatehospital outcome of acute pancreatitis patients admitted into a tertiary care hospital. Materials and Methods: This hospital based cross-sectional type of observational study was conductedat Dhaka Medical College Hospital (DMCH), for one-year period (June 2018-May 2019).Total 106established cases of acute pancreatitis were included in this study. Data was analyzed by the SPSS 22Windows version and graph &amp; chart were expressed by using SPSS 22 and MS Excel. The Result waspresented with tables and charts. Results: Among 106 patients, mean age of the patients was 42.5 ±11.3 SD (years), with male predominance(male: female-1.2:1). All of the patients complained abdominal pain (100%) while anorexia (48.1%), 43.4%had vomiting and 31.1% had fever. Regarding clinical signs, abdominal distension (45.3%), paralytic ileus(34.9%) and dehydration (43.4%) were found to be the major clinical signs. The common location of painwas in epigastric region (73.6%) with radiation to back in 20.8% patients. Pain was severe agonizing innature in 76.4% cases. Of all, gall stone disease (17.0%) was the most prevalent cause. According toAPACHE-II score, 74.5% patients had mild pancreatitis (APACHE-II &lt;8) while according to Glasgowcriteria, 66.0% had mild disease (Glasgow score &lt;3). Mean APACHE-II score was 7.07±2.50 and Glasgowscore was 2.90±2.33. Mean hospital stays were 8.9±3.6 days and NPO (nothing per oral) 4.9±1.9 days.Among the patients, 77.4% patients were alive and mortality rate was 22.6%. Conclusion: Although, a larger portion of the patients had no identifiable cause but gall stone was themost common etiology. Pain commonly located in epigastric region with radiation to back. Of all thecases, more than sixty percent of the patients had mild pancreatitis estimated by APACHE II score andGlasgow score. Mean hospital stays were about 9 days and nothing per oral was about 5 days. Overallmortality rate was 22.6%. J MEDICINE 2022; 23: 24-29

Heparin-induced rectus sheath hematoma in a COVID-19 patient with pulmonary emboli: a case report and literature review

Introduction: Rectus sheath hematoma (RSH) is an uncommon cause of acute abdominal pain that is often misinterpreted. Only about 2% of patients who present with acute abdominal pain display this condition. Damage to the superior or inferior epigastric arteries or their branches, as well as direct rupture of the rectus abdominis muscle, causes bleeding into the rectus sheath. In hospitalized COVID-19 patients, anticoagulant prophylaxis with heparin has become a standard part of medical care. This method may raise the risk of bleeding in older people with comorbidities. Case presentation: The patient was a 60-year-old woman with a history of asthma and diabetes mellitus who was referred to the emergency department with shortness of breath and cough. Chest X-Ray demonstrated Covid-19 pneumonia. On the second day of hospitalization, after the exacerbation of tachypnea, computed tomography (CT) angiography was performed, and the results confirmed pulmonary embolism; therefore, the therapeutic dose of heparin was initiated. On the 21st day of hospitalization, the patient experienced abdominal pain and was visited by a general surgeon. A large ecchymosis was observed in the periumbilical; nonetheless, there was no significant tenderness in the abdominal exam. The patient's hemoglobin dropped to 7.9 mg/dl at this time. An abdominal and pelvic CT scan showed a 45 mm hematoma in the left rectus muscle. Conclusion: In patients presenting with acute abdominal pain, any physician in the field of emergency or surgery should include RSH in their differential diagnosis list, especially those who have certain predisposing conditions.

Evaluation of preoperative predictive factors that determine difficult laparoscopic interval appendectomy

Background: Appendicitis is one of the most widely recognised causes of acute abdominal pain. A wide range of treatment from medical management using antibiotics to a minimal invasive surgery can be done for appendicitis. The usual classical open approach of appendectomy is time tested treatment. However laparoscopic appendectomy is being increasingly preferred these days over classical open approach in majority of patients suffering from appendicitis. This study was undertaken to evaluate preoperative data that can serve as predictors of difficult laparoscopic appendectomy and help in planning of surgery.Methods: This was a prospective observational study that was done at department of surgery, government medical college, Srinagar for a period of three years. A total of 50 consecutive patients who underwent laparoscopic interval appendectomy were enrolled in this study. Various preoperative factors such as age, gender, body mass index, history of recurrent episodes, history of previous surgery, ultrasonographic findings and a few investigation results were studied to find their association with the difficulty in performing laparoscopic appendectomy and results were tabulated and analysed.Results: This study found a significant relation between body mass index, history of previous surgery, history of multiple episodes, C reactive proteins and difficulty in doing a laparoscopic interval appendectomy. However, we didn’t find any significant relationship between age, gender, ultrasonographic findings, serum bilirubin, transaminase levels, WBC counts and difficult laparoscopic interval appendectomy.Conclusions: Knowledge of these positive factors for difficult laparoscopic appendectomy could help surgeons during pre-operative assessment and take necessary precautions during laparoscopic appendectomy.

Accuracy of point-of-care ultrasonography compared to abdominal X-ray in the diagnosis of small bowel obstruction in emergency patients

Background: Small bowel obstruction (SBO) is a common cause of acute abdominal pain. Many diagnostic modalities are used to diagnose or rule out SBO. Objective: This study aimed to compare the diagnostic accuracy of SBO for point-of-care ultrasound (POCUS) to that of abdominal X-ray (AXR) using computerized tomography (CT) and/or patients&amp;apos; follow-up as the gold standard. Methods: This was a prospective, cohort study of a convenience sample of adult patients, who presented to the emergency department (ED) with signs and symptoms suggestive of SBO. Emergency medicine residents performed POCUS looking for sonographic signs of SBO. Abdominal X-ray and CT results were based on the radiologist&amp;apos;s final report. Results: A total of 77 patients were enrolled in the study. The mean age was 56 years, and the mean BMI was 28 kg/m2. Point-of-care ultrasound had a sensitivity of 90%, specificity of 61%, +likelihood ratio (LR) of 2.3, and -LR of 0.159, compared to AXR, which had a sensitivity of 57%, specificity of 62%, +LR of 1.5, and -LR 0.69. Conclusion: POCUS performed by ED residents for the diagnosis of SBO has high diagnostic accuracy as compared to that of AXR, with a p-value of 0.046. The accuracy is higher if all the sonographic signs are present or absent.

Small bowel obstruction precipitated by intussusception of Meckel’s diverticulum

Small bowel obstruction (SBO) secondary to intussusception of Meckel’s diverticulum (MD) is a rare cause of acute abdominal pain that may warrant urgent surgical treatment. Volvulus or intussusception of the small bowel with presence of MD as the lead point is the most commonly reported etiology of Meckel’s related obstructions. We report an interesting case of a small bowel obstruction caused by the intussusception of an MD within its own lumen. The case involves a 30-year-old male who presented to the emergency room with acute, severe abdominal pain with an abdominal computed tomography (CT) showing a distal high-grade SBO. Decision was made to take the patient to the operating room urgently due to his clinical examination and radiologic imaging, specifically CT scan. Diagnostic laparoscopy was performed and subsequently converted to an exploratory laparotomy, which revealed the intussuscepted MD with focal necrosis into the distal small bowel causing an SBO. A segmental small bowel resection with hand sewn primary anastomosis was performed. The case presents an interesting challenge in deciding when to take a patient with an SBO to the operating room versus initial conservative management and what the treatment should be if an MD is encountered. In addition, the case emphasizes the importance of history and physical exam findings in coordination with radiologic imaging in helping to make appropriate decisions in a timely manner for operative vs conservative management of an SBO. It reminds us that, Meckel’s diverticulum, although less commonly the cause of a small bowel obstruction in the adult population, needs to be on the differential diagnosis and we need to have a high clinical suspicion for this possibility to ensure appropriate treatment in a timely manner.

Rupture of Spleen During Pregnancy with Intrauterine Fetal Death Mimicking Rupture Uterus: A Case Report

Background: Splenic rupture in pregnancy or postpartum is a rare and frequently misdiagnosed event. The splenic rupture during pregnancy is difficult to diagnose because it shares signs and symptoms with other conditions such as uterine rupture and abruptio placentae. Case report: We report a case of a 26 years G3P2L2 who had splenic rupture following accidental fall from the stairs. She presented with acute abdominal pain with hemoperitoneum and intrauterine fetal death. Ultrasonography confirmed moderate amount of free fluid and fetal demise without any evidence of retroplacental clots. She was taken up for emergency laparotomy with a provisional diagnosis of rupture uterus. On laparotomy, massive hemoperitoneum due to splenic injury was noted. Hence, Splenectomy was done and she recovered without further complication. Splenic rupture should be considered in cases of trauma to the abdomen during pregnancy because of the risk of severe haemorrhage, shock, and possibility of pregnancy loss. The aim of the article is to highlight the fact that rupture of the spleen is an unusual but serious cause of acute abdominal pain in pregnancy and is associated with both maternal and fetal complications. Conclusion: Sudden abdominal pain, pallor, and hypotension following any trauma may be a sign of splenic rupture. Resuscita-tion of patients with immediate laparotomy should be done in these patients to avoid fetal and maternal morbidity and mortality. Hence, it should be one of the differential diagnoses in addition to abruptio placentae and uterine rupture in suspected cases of haemorrhagic shock.