scholarly journals Hemoperitoneum due to Splenic Laceration Caused by Colonoscopy: A Rare and Catastrophic Complication

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Shiao-Han Chen ◽  
Jiann-Ruey Ong ◽  
Hon-Ping Ma ◽  
Po-Shen Chen
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Splenic Flexure ◽  
Splenic Injury ◽  
Underlying Disease ◽  
Sudden Onset ◽  
Health Examination ◽  
Asymptomatic Patients ◽  
Grade Ii

Numerous studies suggest that in asymptomatic patients, routine follow-up CT is not indicated due to the insignificant findings found on these patients. A 53-year-old man, who denied any underlying disease before, underwent colonoscopy for routine health examination. Sudden onset of abdominal pain around left upper quarter was mentioned at our emergency department. Grade II spleen laceration was found on CT scan. Splenic injury was found few hours later on the day of colonoscopy. It might result from the extra tension between the spleen and splenic flexure which varies from different positions of patients.

scholarly journals Intussusception in a pregnant woman

2020 ◽  
Vol 2020 (12) ◽  
Author(s):  
Ana Cristina Silva ◽  
Pedro Soares Moreira ◽  
Vitor Costa Simões ◽  
Mónica Sampaio ◽  
Marisa Domingues Santos
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Pregnant Woman ◽  
Pregnant Patient ◽  
Computed Tomography Scan ◽  
Intestinal Necrosis ◽  
History Of ◽  
Emergent Laparotomy ◽  
Tomography Scan

Abstract Abdominal pain in a pregnant woman with a history of laparoscopic Roux-en-Y gastric bypass (LRYGB) in the emergency department is challenging. Intussusception is a rare cause of small bowel obstruction after LRYGB and can lead to intestinal necrosis, perforation, sepsis and death. The authors report a case of a 34-week pregnant patient, previously submitted to LRYGB, presenting to the emergency department with abdominal pain and vomiting. A computed tomography scan suggested the presence of ileoileal intussusception. So, an emergent laparotomy was performed with invagination reduction. The postoperative period was uneventful, as well as pregnancy and caesarian performed 4 weeks after surgery. At the 45-month follow-up, there was no recurrence of intussusception.

scholarly journals Evaluating Safety and Efficacy of Follow-up for Patients With Abdominal Pain Using Video Consultation (SAVED Study): Randomized Controlled Trial (Preprint)

2019 ◽  
Author(s):  
Dinesh Visva Gunasekeran ◽  
Zhenghong Liu ◽  
Win Jim Tan ◽  
Joshua Koh ◽  
Chiu Peng Cheong ◽  
...  
Keyword(s):  
Emergency Department ◽  
Randomized Controlled Trial ◽  
Abdominal Pain ◽  
Acute Abdominal Pain ◽  
Controlled Trial ◽  
Common Symptom ◽  
Safety And Efficacy ◽  
Randomized Controlled ◽  
Video Consultation

BACKGROUND The benefits of telemedicine include cost savings and decentralized care. Video consultation is one form that enables early detection of deteriorating patients and promotion of self-efficacy in patients who are well but anxious. Abdominal pain is a common symptom presented by patients in emergency departments. These patients could benefit from video consultation, as it enables remote follow-up of patients who do not require admission and facilitates early discharge of patients from overcrowded hospitals. OBJECTIVE The study aimed to evaluate the safety and efficacy of the use of digital telereview in patients presenting with undifferentiated acute abdominal pain. METHODS The SAVED study was a prospective randomized controlled trial in which follow-up using existing telephone-based telereview (control) was compared with digital telereview (intervention). Patients with undifferentiated acute abdominal pain discharged from the emergency department observation ward were studied based on intention-to-treat. The control arm received routine, provider-scheduled telereview with missed reviews actively coordinated and rescheduled by emergency department staff. The intervention arm received access to a platform for digital telereview (asynchronous and synchronous format) that enabled patient-led appointment rescheduling. Patients were followed-up for 2 weeks for outcomes of service utilization, efficacy (compliance with their disposition plan), and safety (re-presentation for the same condition). RESULTS A total of 70 patients participated, with patients randomly assigned to each arm (1:1 ratio). Patients were a mean age of 40.0 (SD 13.8; range 22-71) years, predominantly female (47/70, 67%), and predominantly of Chinese ethnicity (39/70, 56%). The telereview service was used by 32 patients in the control arm (32/35, 91%) and 18 patients in the intervention arm (18/35, 51%). Most patients in control (33/35, 94%; 95% CI 79.5%-99.0%) and intervention (34/35, 97%; 95% CI 83.4%-99.9%) arms were compliant with their final disposition. There was a low rate of re-presentation at 72 hours and 2 weeks for both control (72 hours: 2/35, 6%; 95% CI 1.0%-20.5%; 2 weeks: 2/35, 6%, 95% CI 1.0%-20.5%) and intervention (72 hours: 2/35, 6%; 95% CI 1.0%-20.5%; 2 weeks: 3/35, 9%, 95% CI 2.2%-24.2%) arms. There were no significant differences in safety (<i>P</i>&gt;.99) and efficacy (<i>P</i>&gt;.99) between the two groups. CONCLUSIONS The application of digital telereview for the follow-up of patients with abdominal pain may be safe and effective. Future studies are needed to evaluate its cost-effectiveness and usefulness for broader clinical application. CLINICALTRIAL ISRCTN Registry ISRCTN28468556; http://www.isrctn.com/ISRCTN28468556.

scholarly journals Evaluating Safety and Efficacy of Follow-up for Patients With Abdominal Pain Using Video Consultation (SAVED Study): Randomized Controlled Trial

10.2196/17417 ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. e17417 ◽  
Author(s):  
Dinesh Visva Gunasekeran ◽  
Zhenghong Liu ◽  
Win Jim Tan ◽  
Joshua Koh ◽  
Chiu Peng Cheong ◽  
...  
Keyword(s):  
Emergency Department ◽  
Randomized Controlled Trial ◽  
Abdominal Pain ◽  
Acute Abdominal Pain ◽  
Controlled Trial ◽  
Common Symptom ◽  
Safety And Efficacy ◽  
Randomized Controlled ◽  
Video Consultation

Background The benefits of telemedicine include cost savings and decentralized care. Video consultation is one form that enables early detection of deteriorating patients and promotion of self-efficacy in patients who are well but anxious. Abdominal pain is a common symptom presented by patients in emergency departments. These patients could benefit from video consultation, as it enables remote follow-up of patients who do not require admission and facilitates early discharge of patients from overcrowded hospitals. Objective The study aimed to evaluate the safety and efficacy of the use of digital telereview in patients presenting with undifferentiated acute abdominal pain. Methods The SAVED study was a prospective randomized controlled trial in which follow-up using existing telephone-based telereview (control) was compared with digital telereview (intervention). Patients with undifferentiated acute abdominal pain discharged from the emergency department observation ward were studied based on intention-to-treat. The control arm received routine, provider-scheduled telereview with missed reviews actively coordinated and rescheduled by emergency department staff. The intervention arm received access to a platform for digital telereview (asynchronous and synchronous format) that enabled patient-led appointment rescheduling. Patients were followed-up for 2 weeks for outcomes of service utilization, efficacy (compliance with their disposition plan), and safety (re-presentation for the same condition). Results A total of 70 patients participated, with patients randomly assigned to each arm (1:1 ratio). Patients were a mean age of 40.0 (SD 13.8; range 22-71) years, predominantly female (47/70, 67%), and predominantly of Chinese ethnicity (39/70, 56%). The telereview service was used by 32 patients in the control arm (32/35, 91%) and 18 patients in the intervention arm (18/35, 51%). Most patients in control (33/35, 94%; 95% CI 79.5%-99.0%) and intervention (34/35, 97%; 95% CI 83.4%-99.9%) arms were compliant with their final disposition. There was a low rate of re-presentation at 72 hours and 2 weeks for both control (72 hours: 2/35, 6%; 95% CI 1.0%-20.5%; 2 weeks: 2/35, 6%, 95% CI 1.0%-20.5%) and intervention (72 hours: 2/35, 6%; 95% CI 1.0%-20.5%; 2 weeks: 3/35, 9%, 95% CI 2.2%-24.2%) arms. There were no significant differences in safety (P>.99) and efficacy (P>.99) between the two groups. Conclusions The application of digital telereview for the follow-up of patients with abdominal pain may be safe and effective. Future studies are needed to evaluate its cost-effectiveness and usefulness for broader clinical application. Trial Registration ISRCTN Registry ISRCTN28468556; http://www.isrctn.com/ISRCTN28468556.

scholarly journals Quantity of opioids consumed following an emergency department visit for acute pain: a Canadian prospective cohort study

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e022649 ◽  
Author(s):  
Raoul Daoust ◽  
Jean Paquet ◽  
Alexis Cournoyer ◽  
Éric Piette ◽  
Judy Morris ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Abdominal Pain ◽  
Acute Pain ◽  
Prospective Cohort ◽  
Renal Colic ◽  
Medication Use ◽  
Pain Medication ◽  
Pain Condition

ObjectivesPrescription opioid diversion is a significant contributor to the opioid misuse epidemic. We examined the quantity of opioids consumed by emergency department (ED) discharged patients after treatment for an acute pain condition (musculoskeletal, fracture, renal colic, abdominal pain and other), and the percentage of unused opioids available for potential misuse.DesignProspective cohort study.SettingTertiary care trauma centre academic hospital.ParticipantsA convenience sample of patients ≥18 years who visited the ED for an acute pain condition (≤2 weeks) and were discharged with an opioid prescription. Patients completed a 14-day paper diary of daily pain medication use. To reduce lost to follow-up, participants also responded to standardised phone interview questions about their previous 14-day pain medication use.OutcomesQuantity of morphine 5 mg tablets (or equivalent) prescribed, consumed and unused during a 14-day follow-up. Quantity of opioids to adequately supply 80% of patients for 2 weeks and 95% of patients for the first 3 days was also calculated.ResultsResults for 627 patients were analysed (mean age ±SD: 51±16 years, 48% women). Patients consumed a median of seven tablets of morphine 5 mg (32% of the total prescribed opioids). The quantity of opioids to adequately supply 80% of patients for 2 weeks was 20 tablets of morphine 5 mg for musculoskeletal pain, 30 for fracture, 15 for renal colic or abdominal pain and 20 for other pain conditions. The quantity to adequately supply 95% of patients for the first 3 days was 15 tablets of morphine 5 mg.ConclusionsPatients discharged from the ED with an acute pain condition consumed a median of fewer than 10 tablets of morphine 5 mg (or equivalent). ED physicians should consider prescribing a smaller quantity of opioids and asking the pharmacist to dispense them in portions to minimise unused opioids.Trial registration numberNCT02799004; Results.

Benefit of follow-up CT in emergency department patients with persistent non-traumatic abdominal pain

2010 ◽  
Vol 18 (1) ◽  
pp. 5-9 ◽  
Author(s):  
Ashwin V. Asrani ◽  
Jamlik-Omari F. Johnson ◽  
Robert A. Novelline
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Emergency Department Patients

scholarly journals Long-term Emergency Department Visits and Readmissions After Laparoscopic Roux-en-Y Gastric Bypass: a Systematic Review

2021 ◽  
Author(s):  
N. van Olst ◽  
A. S. van Rijswijk ◽  
S. Mikdad ◽  
L. J. Schoonmade ◽  
A. W. van de Laar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Gastric Bypass ◽  
Abdominal Pain ◽  
Emergency Department Visits ◽  
Cochrane Library ◽  
Term Care ◽  
Ed Visits

Abstract Purpose There is considerable evidence on short-term outcomes after laparoscopic Roux-en-Y gastric bypass (LRYGB), but data on long-term outcome is scarce, especially on postoperative emergency department (ED) visits and readmissions. We aim to systematically review evidence on the incidence, indications, and risk factors of ED visits and readmissions beyond 30 days after LRYGB. Materials and Methods A systematic search in PubMed, Scopus, Embase.com, Cochrane Library, and PsycINFO was performed. All studies reporting ED visits and readmissions > 30 days after LRYGB, with ≥ 50 patients, were included. PRISMA statement was used and the Newcastle-Ottawa Scale for quality assessment. Results Twenty articles were included. Six studies reported on ED visits (n = 2818) and 19 on readmissions (n = 276,543). The rate of patients with an ED visit within 90 days after surgery ranged from 3.9 to 32.6%. ED visits at 1, 2, and 3 years occurred in 25.6%, 30.0%, and 31.1% of patients. Readmissions within 90 days and at 1-year follow-up ranged from 4.1 to 20.5% and 4.75 to 16.6%, respectively. Readmission was 29% at 2 years and 23.9% at 4.2 years of follow-up. The most common reason for ED visits and readmissions was abdominal pain. Conclusion Emergency department visits and readmissions have been reported in up to almost one in three patients on the long-term after LRYGB. Both are mainly indicated for abdominal pain. The report on indications and risk factors is very concise. A better understanding of ED visits and readmissions after LRYGB is warranted to improve long-term care, in particular for patients with abdominal pains.

scholarly journals Graves’ Disease Presenting with Periodic Paralysis to the Emergency Department

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Nick Si Rui Lan ◽  
P. Gerry Fegan
Keyword(s):  
Emergency Department ◽  
Muscle Weakness ◽  
Sudden Onset ◽  
Periodic Paralysis ◽  
Lower Limbs ◽  
Graves Disease ◽  
Antibody Testing ◽  
Thyrotoxic Periodic Paralysis ◽  
Electrolyte Replacement

Thyrotoxic periodic paralysis is an infrequent manifestation of hyperthyroidism and an uncommon cause of muscle weakness in western countries. The diagnosis should be considered in the differential when a patient presents with transient and recurrent weakness associated with hypokalaemia. We present a case of a 26-year-old Asian male presenting with sudden onset muscle weakness affecting predominantly his lower limbs on a background of weight loss. Physical examination demonstrated symmetrical proximal muscle weakness with normal sensation and reflexes. Initial biochemical investigations revealed hypokalaemia, hypomagnesaemia, and hyperthyroidism. Intravenous electrolyte replacement was administered in the emergency department. The patient’s symptoms resolved during inpatient admission. Subsequent TSH receptor antibody testing and radionuclide thyroid scan confirmed a diagnosis of Graves’ disease. The patient was discharged on antithyroid medication with no further episodes of weakness on follow-up. Therefore, thyrotoxic periodic paralysis can be the presenting feature of previously undiagnosed Graves’ disease and should be considered in the differential diagnosis in patients presenting with weakness.

scholarly journals Bedside Point-of-Care Ultrasound of an Adult with Diffuse Intermittent Abdominal Pain

2020 ◽  
Vol 19 (1) ◽  
pp. 49-51
Author(s):  
Jamaji C Nwanaji-Enwerem ◽  
◽  
Adaira Landry ◽  
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Point Of Care ◽  
Sudden Onset ◽  
Point Of Care Ultrasound ◽  
Intermittent Abdominal Pain ◽  
Obesity Status ◽  
History Of ◽  
History Of Obesity ◽  
New Onset

A 29-year-old woman with a history of obesity status post Roux-en-Y gastric bypass greater than five years prior presented to the emergency department with four hours of sudden-onset stabbing left-sided abdominal pain associated with nausea and non-bloody emesis. She denied melaena and hematochezia, but did report two weeks of diarrhoea that was unchanged with this new onset abdominal pain.

scholarly journals Internal double omental hernia: a rare cause of acute abdomen

2020 ◽  
Vol 2020 (3) ◽  
Author(s):  
André C Pacheco ◽  
Maria J Jervis ◽  
Joana Pimenta ◽  
Ricardo Escrevente ◽  
Fátima Caratão
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Internal Hernia ◽  
Acute Abdominal Pain ◽  
Epigastric Pain ◽  
Sudden Onset ◽  
Postoperative Adhesions ◽  
Common Causes

Abstract Small bowel obstruction is one of the most common causes for acute abdominal pain leading to surgical admissions, occurring most frequently due to postoperative adhesions. Although less common, internal hernia is also a possible etiology, in which a delay on its therapy may lead to a not so dismal morbidity and mortality. Here, we report the case of a 24 year old Caucasian man that was admitted in our emergency department with an inaugural episode of sudden-onset epigastric pain associated with vomiting. After observation and diagnostic workup, the patient underwent urgent laparotomy that revealed an ischemic small bowel due to a double omental hernia, being successfully treated without enteric resection.

scholarly journals Pneumatosis cystoides intestinalis in an elderly patient, better to be safe than sorry

2020 ◽  
Vol 2020 (4) ◽  
Author(s):  
Gabriel A Molina ◽  
Germanico Fuentes ◽  
Monica Elizabeth Orejuela ◽  
Juan Marcelo Herrera ◽  
Galo Enrique Jiménez ◽  
...  
Keyword(s):  
Elderly Patient ◽  
Emergency Department ◽  
Abdominal Pain ◽  
Conservative Therapy ◽  
Current Treatment ◽  
Pneumatosis Cystoides Intestinalis ◽  
Clinical Awareness

Abstract Pneumatosis cystoides intestinalis is a rare pathology with nonspecific symptoms that can be easily misdiagnosed. Clinical awareness along with close surveillance is critical to effectively diagnose and treat this condition. Current treatment is based on conservative therapy including antibiotics and oxygen. Surgery is only recommended when complications are suspected. Here, we present the case of a 72-year-old female admitted to the emergency department with abdominal pain and vomits. Pneumatosis cystoides intestinalis was diagnosed and was successfully treated. On follow-up visits, patient is recovering and doing well.

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