An Unusual Diagnosis that Started with Abdominal Pain

​BY BILLY ZHANG; KRISTEN HUGHES; SHAMIM KHAN, MD; FRANCISCO JACOME, MDA 51-year-old woman presented to the emergency department with severe mid-abdominal pain that had begun early that morning and progressively worsened. The patient also reported having loose bloody stools, bouts of nausea, and several episodes of vomiting yellow bilious fluid.Her medical history was negative for similar episodes. Past medical history was significant for asthma, gastroesophageal reflux disease, hyperlipidemia, hypertension, colonic polyps, constipation, and thyroid disease. Surgical history included cholecystectomy, C-section, and Nissen fundoplication. Social history was significant for smoking. Her vital signs were within normal limits, but complete blood counts showed white blood cells were elevated to 16.58 thous/uL with left shift of neutrophils, 11.6%. Abdominal CT scan demonstrated the classic target-like sign (photo), indicating an intussusception of the ileocolic area with secondary partial bowel obstruction. (BMJ Case Rep 2014 Jun 20; 2014, doi: 10.1136/bcr-2013-203156; Radiol Med 2015;120[1]:105.)Sudden Pain OnsetClinically, intussusception presents with sudden onset of episodic cramping and abdominal pain. It may be associated with emesis, blood in stool, and an elongated mass of the upper right quadrant. (Acta Chir Belg 2015;115[5]:327.) Diagnosis is made using CT scan, and it should show the classic “bull's eye” appearance of the affected segment of bowel....
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research