September 2021: Agonizing Belly Pain

​“I need something for this pain. I think I need surgery."He looked like he was in agony. This 20-something patient looked like a kid, and he didn't seem like he would be crying unless it was excruciating.But his belly seemed pretty benign. I wouldn't have been surprised if he had had rebound because he motioned to his xiphoid. The picture could have fit a perforation. An ulcer could have done this to him. He didn't drink alcohol, so that put pancreatitis lower on the list.Kidney stones can make men look like they are giving birth, but no blood was in the urine, and he had only mid-abdominal pain. It did seem like pain out of proportion to exam. Ischemic bowel? But why? He had no prior surgery, and no hernias were found.An unexpected CT scout! The coffee bean (or bent intertube) pointing to the right lower quadrant. Of course, he had a cecal volvulus. They account for only about 10 percent of intestinal obstructions, usually in younger patients, and they can often be just because of a developmentally failed peritoneal fixation with a hypermobile bowel. He would need to go to surgery, just like he said.​But the CT cuts challenged the location. In fact, the bird's beak pointed to the left lower quadrant. A whirl sign was noted there too. It was actually a sigmoid volvulus!Often these can be decompressed by a colonoscopy. Unfortunately, surgery is sometimes necessary immediately, such as when a patient has bowel ischemia, infarction, or perforation.​This patient did...
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