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Critical care ultrasound findings at the McBurney's point (A), reverse McBurney's point (B), and left upper quadrants (C). D = diaphragm, EF = echogenic fluid, L = lung, R = reverberation, S = rib shadow.
Source publication
Rationale
Critical care ultrasound identifies the signs of free intraperitoneal air and echogenic free fluid always indicates hollow viscus perforation (HVP) and needs immediate surgical interventions. However, in rare cases, these classic signs may also mislead proper clinical decisions. We report perforated viscus associated large peritoneal effu...
Context in source publication
Context 1
... CT examination as unstable blood pressure. Therefore, critical care ultrasound was used to identify the evidence of HVP. At McBurney's point, ultrasound detected several reverberation lines which highly indicated free air. The large echogenic free fluid was identified at reverse McBurney's point and even in the left upper quadrant of the abdomen (Fig. 1). However, there was no pleural effusion and satisfactory images in Morison's pouch were not obtained. The above imaging findings seem to support HVP. Further diagnostic puncture at the reverse McBurney's point collected dark "unclotted blood," which seem to further confirm the initial diagnosis of ...
Citations
... [1,2] However, gastric tube insertion is prone to reflexive swallowing reaction, resulting in difficult intubation or pharyngeal injury. [3] In addition, comatose patients also have a combined endotracheal tube that compresses the esophageal opening, which further increases the difficulty of intubation. [4] Therefore, how to safely and quickly insert a gastric tube is a challenge for ICU nursing staff. ...
Background:
We designed this systematic review and meta-analysis protocol to provide new medical evidence for clinical management by comparing the prognostic outcomes of visual laryngoscopy with those of conventional blinded insertion methods.
Methods:
We will intend to search English databases including Medicine, Embase, Web of Science, Cochrane Central Register of Controlled Trials, Scopus, and Google Scholar. The Chinese databases, such as Wanfang, China Knowledge Network, and China Biomedical Literature Database will also be searched. The outcome measures include intubation success rate, pain score, intubation-related complications, patient satisfaction, operation time, and cost. The Jadad scale will be used to evaluate the methodological quality of each randomized controlled trial in this meta-analysis. We will use the Methodological Index of Non-Randomized Studies criteria to assess the risk of bias in non-randomized study. An I2 value greater than 50% indicates the presence of significant heterogeneity. P < .05 in a 2-tailed test is considered statistically significant.
Results:
It is hypothesized that video laryngoscope will provide better outcomes compared with traditional blind gastric tube insertion.
Conclusions:
The results of our review will be reported strictly following the PRISMA criteria and the review will add to the existing literature by showing compelling evidence and improved guidance in clinic settings.
... Benign etiologies include PUD, Crohn's disease, pancreatitis, prolapsed gastric polyps, eating disorders, [8] gastric bezoar, gastric volvulus, Bouveret syndrome, [9] and superior mesenteric artery syndrome. [10] The most common clinical features of GOO are epigastric pain, postprandial vomiting, distention, early satiety, and weight loss. [11] On rare occasions, patients may present with progressively worsening abdominal distention with massive gastric enlargement. ...
Chronic massive gastric distention is a rare condition that can occur due to an underlying obstruction or dysmotility. Gastric outlet obstruction (GOO) is often the culprit that can manifest as the result of the luminal, mural, or extrinsic compression. Gastric adenocarcinoma can rarely manifest as massive gastric distention due to partially obstructing mass or peptic stricture. Severe and fatal sequelae may develop, if early detection and appropriate intervention are delayed, such as gastric decompression, endoscopic evaluation and/or surgical resection. Herein, we present a case of a 60‑year‑old male who presented with progressive worsening of nonspecific symptoms over the 8‑month period. He was found to have remarkable massive gastric distention on imaging which was chronic in etiology secondary to GOO due to metastatic signet‑ring cell gastric adenocarcinoma.
... Due to low suspicion index and delay in diagnosis of SMA syndrome, most of the patients present late with a long-standing history of upper abdominal discomfort, intermittent vomiting, and weight loss which could last up to 8 to 28 months [3,9,10]. Rarely, as in this case, the patient could present acutely with gastric dilation and upper intestinal ileus [3,[11][12][13] mimicking more common causes of acute vomiting such as gastroenteritis, pancreatitis, peptic ulcer disease, cholecystitis, mesenteric ischemia, and medication-related side effects [14,15]. Mortality has also been reported due to gastric necrosis and perforation as a complication of the condition [11,13]. ...
... Rarely, as in this case, the patient could present acutely with gastric dilation and upper intestinal ileus [3,[11][12][13] mimicking more common causes of acute vomiting such as gastroenteritis, pancreatitis, peptic ulcer disease, cholecystitis, mesenteric ischemia, and medication-related side effects [14,15]. Mortality has also been reported due to gastric necrosis and perforation as a complication of the condition [11,13]. ...
Background:
Superior mesenteric artery (SMA) syndrome is a rare cause of upper gastrointestinal obstruction leading to acute kidney injury (AKI).
Methods:
We report a case of 23-year-old army personnel who presented with persistent vomiting leading to severe hypokalaemia, metabolic alkalosis, and acute kidney injury resulting in cardiorespiratory arrest.
Results:
After successful resuscitation, he was supported with haemodialysis and aggressive electrolytes correction. He was repeatedly not able to tolerate nasogastric (NG) tube feeding and computerised tomography of abdomen was performed, and the diagnosis of SMA syndrome was made. Gastroscopy examination revealed duodenal ulcer at D1, pinhole D1-D2 junction, but there was no evidence of intraluminal mass or lesions leading to upper gastrointestinal obstruction. A nasojejunal tube was inserted to bypass the narrow segment of the duodenum, and he was put on nutritional support. He was subsequently weaned off dialysis support as his renal function gradually improved and later on normalised. He remains symptoms free, and he gained five kilograms in four months after discharge.
Conclusions:
SMA syndrome is a rare cause of upper gastrointestinal obstruction but should be considered as a differential diagnosis in a patient who presented with recurrent vomiting and AKI with metabolic alkalosis.
