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A Curious Case of Right Upper Quadrant Abdominal Pain
Andrew Grock1, Wendy Chan2, Ian S deSouza2
1Olive 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.
The Western Journal of Emergency Medicine
|September 15, 2016
Summary
Midgut volvulus, a rare adult condition, can cause bowel obstruction and ischemia. Early recognition of free intraperitoneal fluid on bedside ultrasound is crucial for emergency physicians to prevent bowel necrosis.
Area of Science:
- Gastroenterology
- Emergency Medicine
- Diagnostic Imaging
Background:
- Midgut volvulus is a rare cause of small bowel obstruction in adults.
- Delayed diagnosis and treatment can lead to intestinal ischemia and necrosis.
- Bedside ultrasound is an accessible tool for initial patient assessment.
Observation:
- A 36-year-old man presented with acute right upper quadrant abdominal pain and vomiting.
- Bedside ultrasound revealed a normal gallbladder but significant free intraperitoneal fluid.
- Subsequent CT and laparotomy confirmed small bowel obstruction secondary to midgut volvulus.
Findings:
- The patient was diagnosed with midgut volvulus leading to small bowel obstruction and ischemia.
- Surgical intervention was required for definitive management.
- Free intraperitoneal fluid on ultrasound can be an indicator of serious intra-abdominal pathology.
Implications:
- Emergency physicians should consider midgut volvulus in adults presenting with acute abdominal symptoms.
- Bedside ultrasound findings, such as free fluid, warrant further urgent investigation.
- Prompt diagnosis and surgical intervention are critical to prevent bowel necrosis and improve patient outcomes.
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