The American journal of emergency medicine
-
Case Reports
Cecal pneumatosis intestinalis in obstructing sigmoid cancer in ED: Emergency metallic stenting.
An 85-year-old man presented with acute abdomen. Abdominal computed tomography revealed obstructing sigmoid colon cancer with pneumatosis intestinalis of the ascending colon. A surgeon was consulted for colonic obstruction with impending sepsis, who declined surgery considering the patient's advanced age. ⋯ Normal stool passage was achieved after this, and the patient survived the 9-month follow-up period. Acute colonic obstruction from obstructive colon cancer requires emergency management, wherein the presence of pneumatosis intestinalis poses a high risk of cecal perforation. Emergency endoscopic colonic metallic stent placement provides an alternative therapy, particularly when surgery is not feasible, as described here.
-
Pulmonary embolism (PE) is a common emergency department (ED) diagnosis with a wide range in mortality rates. Methods to identify and risk-stratify PE, including measuring right ventricular strain (RVS) by echocardiography (echo), are essential in providing effective and efficient care. A limited echo examination aims to expedite and increase availability of RVS determination through assessment at the bedside by the ED provider. ⋯ In this retrospective cohort study, limited echo demonstrated moderate agreement with consultative echo for RVd. Right ventricular dilation on limited echo was highly specific for RVS but had low sensitivity.