Luck or Wisdom?

Some might say it would be better to be lucky than good. Others might say it is crucial to maintain a high index of suspicion. In emergency medicine, clearly both are true.   Here is a humbling case of a fortunate diagnosis made by a colleague.   A 42-year-old woman with a history of hypertension and schizophrenia presented to the emergency department with a day of left flank pain. She had a decreased appetite and didn't remember her last bowel movement, but had no fevers, chills, vomiting, or vaginal or urinary symptoms. She had left upper quadrant tenderness, perhaps with some guarding. The urine dip was unremarkable. The WBC was 14.3. An uncontrasted, abdominal CT scan was obtained.               Surgery consultation was obtained for the suspected 3 cm foreign body in her proximal descending colon. An impaled fishbone was removed during colonoscopy.     I will concede, ingested foreign body would be listed on an exhaustive differential diagnosis list for abdominal pain, but it isn't one that I tend to consider. Fortunately, most ingested foreign bodies traverse the GI tract without problems. When an ingested foreign body causes problems in the bowels, the inciting object is usually long, sharp, and double-pointed. Toothpicks are most commonly reported. A PubMed search pops up a couple non-toothpick impacted bowel foreign body case reports — two with fishbones and one with a lollipop stick! Reading these cases can be frightening.   Keep in mind:• It ...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs