Limits...
Pre-pyloric Gastric perforation, cocaine abuse

Parisek SIP - MedPix (2009)

View Article: MedPix Image - MedPix Case

Affiliation: Affiliation Unlisted - Please See Comments

ABSTRACT

Diagnosis: Pre-pyloric Gastric perforation, cocaine abuse

History: 19 y.o. man who presents w/ six hours of severe epigastric and upper abdominal pain, radiating to his back. He volunteered that he had been smoking cocaine (crack) one hour prior to the start of his symptoms. Social history is positive for EtOH (six drinks daily), tobacco, and cocaine abuse. He has no prior medical or surgical history and no previous abdominal complaints.

Findings: Single AP supine view of abdomen demonstrates a thin line of gas in the right upper quadrant, concerning for free air. Mildly distended prominent centralized loops of small bowel are seen in the mid abdomen which may represent a regional ileus. Gas is seen outlining the left psoas muscle. Single AP frontal view of chest demonstrates a subtle area of lucency under the right hemidiaphragm suspicious for free air in the abdomen. No pneumothorax is noted.

Ddx: Abdominal free-air: • Perforated hollow viscus (eg. gastric - peptic ulcer disease) • Ischemic enteritis • Pneumomediastinum/pneumothorax decompressing into abdomen • Gas-forming bacterial peritonitis • Penetrating trauma to abdomen

Dxhow: Exploratory Lapartomy

Exam: • Vital signs: stable, afebrile, with mild sinus tachycardia. • Abdomen is soft, non-distended with positive bowel sounds, but with positive guarding and rebound tenderness. • WBC count eleated at 15.1, lactic acid 2.5 mmol/L (high), potassium 6.4 mmol/L (critical high), urinalysis positive for protein, ketones and urobilinogen.

No MeSH data available.


Closeup of the AP frontal view of chest demonstrates a subtle curvilinear area of lucency under the right hemidiaphragm (arrows) - free intra-peritoneal air in the abdomen.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=MPX1405&req=5

MPX1405_synpic51424: Closeup of the AP frontal view of chest demonstrates a subtle curvilinear area of lucency under the right hemidiaphragm (arrows) - free intra-peritoneal air in the abdomen.


Pre-pyloric Gastric perforation, cocaine abuse

Parisek SIP - MedPix (2009)

Closeup of the AP frontal view of chest demonstrates a subtle curvilinear area of lucency under the right hemidiaphragm (arrows) - free intra-peritoneal air in the abdomen.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1405&req=5

MPX1405_synpic51424: Closeup of the AP frontal view of chest demonstrates a subtle curvilinear area of lucency under the right hemidiaphragm (arrows) - free intra-peritoneal air in the abdomen.

View Article: MedPix Image - MedPix Case

Affiliation: Affiliation Unlisted - Please See Comments

ABSTRACT

Diagnosis: Pre-pyloric Gastric perforation, cocaine abuse

History: 19 y.o. man who presents w/ six hours of severe epigastric and upper abdominal pain, radiating to his back. He volunteered that he had been smoking cocaine (crack) one hour prior to the start of his symptoms. Social history is positive for EtOH (six drinks daily), tobacco, and cocaine abuse. He has no prior medical or surgical history and no previous abdominal complaints.

Findings: Single AP supine view of abdomen demonstrates a thin line of gas in the right upper quadrant, concerning for free air. Mildly distended prominent centralized loops of small bowel are seen in the mid abdomen which may represent a regional ileus. Gas is seen outlining the left psoas muscle. Single AP frontal view of chest demonstrates a subtle area of lucency under the right hemidiaphragm suspicious for free air in the abdomen. No pneumothorax is noted.

Ddx: Abdominal free-air: • Perforated hollow viscus (eg. gastric - peptic ulcer disease) • Ischemic enteritis • Pneumomediastinum/pneumothorax decompressing into abdomen • Gas-forming bacterial peritonitis • Penetrating trauma to abdomen

Dxhow: Exploratory Lapartomy

Exam: • Vital signs: stable, afebrile, with mild sinus tachycardia. • Abdomen is soft, non-distended with positive bowel sounds, but with positive guarding and rebound tenderness. • WBC count eleated at 15.1, lactic acid 2.5 mmol/L (high), potassium 6.4 mmol/L (critical high), urinalysis positive for protein, ketones and urobilinogen.

No MeSH data available.