 | Zac Robinson & Viet Tran A 70 year old female presented to the ED with abdominal pain. A POCUS was performed... |
Presenting Complaint
1/52 worsening abdominal pain, subjective distension, several small loose stools today. Passing flatus. No vomiting.
Past History
Appendicectomy, cholecystectomy, hysterectomy (converted to laparotomy at the time, so large midline incision).
Examination
POCUS was performed (images by Z Robinson) with acquisition method gained by running the probe over the abdomen in a lawnmower pattern and the 2 most useful images provided:
1/52 worsening abdominal pain, subjective distension, several small loose stools today. Passing flatus. No vomiting.
Past History
Appendicectomy, cholecystectomy, hysterectomy (converted to laparotomy at the time, so large midline incision).
Examination
- HR 100
- BP 110/74
- RR 20
- O2 Sat 99%
- T 36.2C
- Generally tender abdomen to palpation, not peritonitic
POCUS was performed (images by Z Robinson) with acquisition method gained by running the probe over the abdomen in a lawnmower pattern and the 2 most useful images provided:
What do the above images suggest?
The clip on the left shows a cluster of dilated fluid filled bowel loops. Viewed in short access there may be pockets of free fluid outside the bowel loops, best seen in the lower right hand side of the image. This interloop free fluid is referred to as Tanga Sign.
The second clip shows back and forth (or to and fro) peristalsis.
The patient had a high-grade small bowel obstruction on subsequent CT requiring surgical management.
The second clip shows back and forth (or to and fro) peristalsis.
The patient had a high-grade small bowel obstruction on subsequent CT requiring surgical management.
So how has POCUS changed management?
So you've diagnosed the bowel obstruction on POCUS. Now what?
The CT that was going to diagnose the obstruction and provide more detail on where and why it came to be has to be ordered anyway right?
The beauty of having POCUS in your armamentarium allows you to increase the pre-test probability of the CT as well as early inpatient referral and other patient flow processes.
The CT that was going to diagnose the obstruction and provide more detail on where and why it came to be has to be ordered anyway right?
The beauty of having POCUS in your armamentarium allows you to increase the pre-test probability of the CT as well as early inpatient referral and other patient flow processes.
| Zac is an ED registrar at RHH with an interest in POCUS (Currently using a first generation Butterfly iQ) |
RSS Feed
