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SAEM Clinical Images Series: Leg Rash

ulcer

A 42-year-old male with no significant medical problems presented to the Emergency Department with a 5-week history of abdominal pain and bloody diarrhea. He also reported painful intraoral blisters and ulcerative lesions on the bilateral lower extremities and scrotum. The patient had been self-managing his symptoms with over-the-counter antidiarrheal medications and has unsuccessfully attempted to establish care with a gastroenterologist. He denied any history of intravenous drug use, cutaneous injections, or previous skin infections and has no other complaints at this time.

 

Vitals: BP 125/85; HR 97; R 22; T 99.2°F; O2 sat; 100% on room air

General: Overall well-appearing but uncomfortable.

HEENT: Dry mucous membranes, no lesions seen.

Respiratory: Clear to auscultation.

Cardiovascular: Regular rhythm without murmurs, rubs, or gallops.

Abdominal: Mild diffuse tenderness on palpation of abdomen without rebound or guarding. Bowel sounds mildly hyperactive.

Genitourinary: External purulent lesion on anus. Gross bright red blood on digital rectal exam.

Skin: Overall pallor, there are Scattered purulent ulcers on bilateral lower extremities and scrotum. Image 1 shows a lesion on the inner right thigh. Image 2 shows a second lesion on the right inner buttock. The right inner thigh lesion has been present longer.

WBC: 17.9

Hgb: 10.6

Plt: 654,000

ESR: 112

CRP: 21.8

Pyoderma gangrenosum

Ulcerative colitis

This rash is consistent with ulcerative pyoderma gangrenosum (PG), a rare inflammatory condition which may occur in isolation or in association with systemic diseases. PG typically manifests as an erythematous nodule or pustule that progresses to form a purulent or necrotic ulcerative base. The lower extremities are the most frequently affected sites. In this patient, the presence of abdominal pain, hematochezia, and elevated inflammatory markers raises suspicion for an underlying diagnosis of ulcerative colitis. Measurement of fecal calprotectin may provide additional diagnostic support. Management of mild flares in an outpatient setting may include rectal or oral mesalamine (5-ASA) in combination with oral prednisone. Severe exacerbations often require hospitalization for systemic glucocorticoid therapy and gastroenterology consultation. The patient was started on IV glucocorticoids and during his admission had resolution of his rectal bleeding and improvement in his rash. Colonoscopy results confirmed the underlying diagnosis of ulcerative colitis. The patient was discharged in stable condition with outpatient gastroenterology follow-up.

Take-Home Points

  • Pyoderma gangrenosum features erythematous nodules and pustules that progress to form a purulent or necrotic base, and is associated with inflammatory bowel diseases.

  • Severe cases of PG generally require glucocorticoid therapy.

  • Ruocco E, Sangiuliano S, Gravina AG, Miranda A, Nicoletti G. Pyoderma gangrenosum: an updated review. J Eur Acad Dermatol Venereol. 2009 Sep;23(9):1008-17. doi: 10.1111/j.1468-3083.2009.03199.x. Epub 2009 Mar 11. PMID: 19470075.
  • Ko CW, Singh S, Feuerstein JD, Falck-Ytter C, Falck-Ytter Y, Cross RK; American Gastroenterological Association Institute Clinical Guidelines Committee. AGA Clinical Practice Guidelines on the Management of Mild-to-Moderate Ulcerative Colitis. Gastroenterology. 2019 Feb;156(3):748-764. doi: 10.1053/j.gastro.2018.12.009. Epub 2018 Dec 18. PMID: 30576644; PMCID: PMC6858922.

Copyright

Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2025 SAEM Annual Meeting | Copyrighted by SAEM 2025 – all rights reserved. View other cases from this Clinical Image Series on ALiEM.



By |2025-11-09T21:14:32-08:00Nov 10, 2025|Dermatology, Gastrointestinal, SAEM Clinical Images|
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SAEM Clinical Images Series: There’s a Bird Stuck in Your Throat

esophagram

The patient is a 61-year-old female with a past medical history of hypertension who presents to the Emergency Department for dysphagia. She states that for the past couple of months, she has experienced some discomfort in her chest as well as progressively worsening pain with swallowing. She was initially able to swallow thoroughly macerated solids and liquids, however over the past several days, she has been unable to tolerate either. She states whenever she eats or drinks something, she feels like the food gets stuck in her chest, causing her to regurgitate it. She denies any other complaints at this time.

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 No additional images

Vitals: All vital signs are normal.

General: Patient is in no acute distress.

HEENT: Mucous membranes are moist, no signs of mass or foreign body.

Respiratory: Clear to auscultation, no increased work of breathing.

Cardiovascular: Regular rate and rhythm, no murmurs.

Abdomen: Normal.

The esophagram shows the classic “bird’s beak” finding associated with Achalasia.

Dysphagia can be broken down into two categories, transfer dysphagia and transport dysphagia. Transfer dysphagia involves the oropharynx. The differential includes stroke, Parkinson’s disease, degenerative diseases such as multiple sclerosis, brain stem tumors, post-infectious causes due to polio and syphilis, peripheral neuropathy, myasthenia gravis, polymyositis, dermatomyositis, and muscular dystrophy. Transport dysphagia, as this patient has, involves the esophagus. The differential includes achalasia, diffuse esophageal spasm, ingested foreign body, esophageal web, malignancy, Schatzki ring, scleroderma, strictures, vascular compression, and Zenker’s diverticulum. The classic finding of Achalasia is a “bird’s beak” appearance on XR esophagram, as seen in the image. The esophagus tapers smoothly into a narrow gastroesophageal junction due to a hypertensive lower esophageal sphincter. There may also be dilation of the proximal esophagus, reduced or absent peristalsis on fluoroscopy, air-fluid levels in the esophagus, absence of intra-gastric air, and/or a sigmoid-like appearance of the esophagus.

Take-Home Points

  • Gastroenterology consultation is warranted if a diagnosis of achalasia is suspected, as esophagogastroduodenoscopy (EGD) is the next step in diagnosis and management.
  • The timing of EGD depends on the degree of dysphagia at presentation and speed of symptom progression.

Momodu II, Wallen JM. Achalasia. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. Spieker MR. Evaluating dysphagia. Am Fam Physician. 2000 Jun 15;61(12):3639-48. PMID: 10892635.

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Copyright

Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2025 SAEM Annual Meeting | Copyrighted by SAEM 2025 – all rights reserved. View other cases from this Clinical Image Series on ALiEM.

By |2025-10-27T08:28:54-07:00Oct 6, 2025|Gastrointestinal, SAEM Clinical Images|
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SAEM Clinical Images Series: A Rare Cause of Dyspnea

pneumopericarditis

A 73-year-old female with past medical history significant for Roux-en-Y gastric bypass 14 years prior complicated by gastro-jejunal ulcers, rheumatoid arthritis on daily prednisone for six months, coronary artery disease, history of remote pulmonary embolism no longer on anticoagulation, GERD, non-insulin dependent type 2 diabetes, morbid obesity, and chronic obstructive pulmonary disease, presented with two-week progression of dyspnea after a ground level fall. She endorsed pain to her neck, back, and stomach. She denied any chest pain, cough, hemoptysis, fevers, chills, leg pain, leg swelling, wheezing, recent surgeries or hospitalizations, recent travel, or history of tobacco use.

 

Vitals: Temp 98.4°F; HR 81; BP 61/46; RR 19; O2 sat 96% on 6L nasal cannula

General: Not in acute respiratory distress. Appears ill.

Neurologic: A&OX4. Face is symmetrical. Following commands. Moves all four limbs spontaneously.

Cardiovascular: Normal rate and rhythm without murmurs, gallops, or rubs. Heart sounds are muffled. Unable to assess for JVD due to body habitus.

Pulmonary: Lungs clear to auscultation bilaterally. No wheezing, rhonchi, rales. No accessory muscle use. Speaking in full sentences.

Abdominal: Diffusely tender to deep palpation. No rebounding, guarding, or tenderness.

Extremities: DPs 2+ and radials 2+. No asymmetric leg swelling. Legs non-tender.

CBC: WBC 12.5 k/µL, hemoglobin 10.3 g/dL

Lactate: 5.0 mmol/L

ABG: pH 7.34, PaCO2 28.3 mmHg, PaO2 78.5 mmHg, O2 sat 94.5%, bicarb 14.8 mmol/L

Blood glucose: 125 mg/dL

Troponin: 132, 133 ng/L.

EKG: Normal sinus rhythm with low voltage and ST-segment elevations in lead II, V3-V6

The diagnosis is pyopneumopericarditis from a pericardial-jejunal fistula. The differential diagnosis for pneumopericarditis includes a history of blunt or penetrating trauma, thoracic surgery or pericardial fluid drainage, positive pressure ventilation, and infectious pericarditis. In this case, the cause was a fistula likely as a side effect of chronic steroid use, which increases the risk of peptic ulcer disease.

Definitive management requires operative intervention with thoracic surgery. Pneumopericarditis carries a high mortality risk and a high risk for tamponade or cardiogenic shock from myopericarditis, as well as septic shock if infection is also present. Therefore, disposition for these patients usually requires surgical intensive care for close hemodynamic and respiratory monitoring and support. It is prudent to start broad-spectrum antibiotics and obtain blood cultures, as well as intraoperative pericardial fluid cultures to narrow antibiotic selection. CT esophagram and/or endoscopy is often indicated to rule out a pericardial-enteric fistula if there are no other immediate causes unveiled on history and examination. The patient should also receive aspirin and colchicine if concomitant myopericarditis is present.

Take-Home Points

  • Pneumopericarditis requires early, aggressive operative intervention and intensive care management.

  • Use steroids judiciously in patients with known gastritis or peptic ulcer disease.

  • Azzu V. Gastropericardial fistula: getting to the heart of the matter. BMC Gastroenterol. 2016 Aug 19;16(1):96. doi: 10.1186/s12876-016-0510-8. PMID: 27542946; PMCID: PMC4992300.
  • Davidson JP, Connelly TM, Libove E, Tappouni R. Gastropericardial fistula: radiologic findings and literature review. J Surg Res. 2016 Jun 1;203(1):174-82. doi: 10.1016/j.jss.2016.03.015. Epub 2016 Mar 15. PMID: 27338548.
  • Murthy S, Looney J, Jaklitsch MT. Gastropericardial fistula after laparoscopic surgery for reflux disease. N Engl J Med. 2002 Jan 31;346(5):328-32. doi: 10.1056/NEJMoa010259. PMID: 11821509.

Copyright

Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2023 SAEM Annual Meeting | Copyrighted by SAEM 2023 – all rights reserved. View other cases from this Clinical Image Series on ALiEM.

By |2025-03-09T21:57:21-07:00Mar 14, 2025|Cardiovascular, Gastrointestinal, SAEM Clinical Images|
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SAEM Clinical Images Series: Short of Breath and Short on Time

A 62-year-old female presented with shortness of breath that started two days ago which she described as mild to moderate, worse with activity. She denied chest pain, abdominal pain, fever, diaphoresis, syncope, cough, wheezing, sputum production, or emesis. Past medical history was significant for rectal adenocarcinoma metastatic to liver. She was status post radioembolization of liver metastasis from the left lobe and her last chemotherapy was approximately one month prior to presentation.

pneumopericardium

Vitals: T 36.5°C; BP 87/57; HR 91-115; RR 12; O2 sat 94% on 2L NC

General: Ill-appearing.

Cardiovascular: Normal rate and regular rhythm, diminished heart sounds.

Chest: Pulmonary effort normal, normal breath sounds.

Gastrointestinal: Abdomen flat, soft, nontender.

MSK: Cyanotic toes bilaterally with decreased capillary refill.

Neurologic: Diffuse motor weakness, no focal deficit present.

CBC: WBC 18.0, Hgb 9.6, Plt 348

PT: 19.4

INR: 1.6

BMP: Na 126, K 4.4, Cl 100, CO2 13 (20-29), Anion Gap 13, Glucose 107, BUN 54 (7-25), Cr 1.96, Ca 7.7

BNP: 410 (0-100)

Lactic acid: Initial 2.5, repeat 4.0 (0.5-2.0)

EKG: Normal sinus rhythm, normal rate, low voltage QRS.

Pneumopericardium, the presence of air within the pericardial sac, is discovered on imaging. The accumulation of air can result in compression of the heart and interfere with normal functioning. Pneumopericardium on imaging can appear as a characteristic radiolucency around the heart on chest X-ray and CT scan, or as direct visualization of air within the pericardial sac on ECHO. Causes include trauma introducing air into the pericardial sac, infection with gas-producing organisms, procedural complications, barotrauma, or spontaneous occurrence.

Gastropericardial fistula is a rare, life-threatening condition whereby an abnormal communication is created between the stomach and pericardial sac, with less than 100 cases reported in modern literature. This condition usually occurs in the setting of prior gastroesophageal surgery, ulcer perforation, or as in this case, malignant perforation due to breakdown of malignant implants between the liver and the gastric wall adherent to the diaphragm and pericardium. This can lead to frank pneumopericardium and tension physiology, ultimately resulting in death if not promptly diagnosed and treated with urgent pericardial drain placement to ameliorate tension physiology. Definitive therapy is surgical repair.

Take-Home Points

  • Gastropericardial fistula is a rare cause of pneumopericardium, usually in the setting of patients with prior gastroesophageal surgery, gastric ulceration, or malignancy of the stomach.

  • Diagnosis is usually made with a combination of imaging modalities including esophagram/upper GI, CT with water soluble oral contrast, and echocardiogram.

  • Prompt diagnosis and treatment are necessary to prevent the onset of tension physiology.

  • Azzu V. (2016). Gastropericardial fistula: getting to the heart of the matter. BMC gastroenterology, 16(1), 96. https://doi.org/10.1186/s12876-016-0510-8

  • Rathur, A., Al-Mohamad, H., Steinhoff, J., & Walsh, R. (2021). Chest Pain from Pneumopericardium withGastropericardial Fistula. Case reports in cardiology, 2021, 5143608. https://doi.org/10.1155/2021/5143608

Copyright

Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2023 SAEM Annual Meeting | Copyrighted by SAEM 2023 – all rights reserved. View other cases from this Clinical Image Series on ALiEM.

By |2025-02-26T14:43:04-08:00Feb 27, 2025|Cardiovascular, Gastrointestinal, SAEM Clinical Images|
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SAEM Clinical Images Series: A Rare Gastrointestinal Complication of an Endocrine Emergency

A 54-year-old woman with a history of hypothyroidism, diabetes mellitus type II, COPD, asthma, anxiety, and depression presented to the emergency department via EMS with three days of fatigue, weakness, chills, and shortness of breath without chest pain or cough. Symptoms had been progressively worsening, and she stated she felt as if she could not move her body on presentation. She also noted diarrhea without abdominal pain, melena, or hematochezia. Just prior to arrival the patient’s daughter thought she looked paler and shorter of breath and called EMS after a near syncopal episode. EMS reported that the family was concerned that the patient’s blood glucose level was low. Blood glucose upon EMS arrival was 90 and rose to 150 following their administration of oral glucose. The patient denied fever, recent sick contacts, urinary changes, hematuria, or leg swelling. She reported two missed doses of levothyroxine which was prescribed at a dose of 25 mcg daily. No recent antibiotic use reported.

 

ogilvie syndrome

Vitals: Temp 36.4°C; BP 106/64 mmHg; HR 62 bpm; Resp 16/min; SpO2 96% on RA

General: Patient drowsy, slow to answer questions, sitting with eyes closed. No obvious distress.

Skin: Warm and dry.

Cardiovascular: Regular rate and rhythm without murmur.

Respiratory: Lungs clear to auscultation bilaterally. No respiratory distress.

Abdomen: Soft, non-distended, normal bowel sounds, diffuse abdominal discomfort to palpation, which she states is chronic.

Neurological: Oriented to person, place, time. CN II-XII intact. No focal neurological deficit observed, strength 4+/5 throughout able to hold all extremities up when placed above the body.

Extremities: No obvious swelling.

CBC: Hb 11.5, WBC 9.5, Plt 186

BMP: Na 141, K 3.8, Cl 105, CO2 24, BUN 17, Cr 1.3

LFTs: AST 20, ALT 11, Bili 0.4

VBG: pH 7.28, PCO2 60, HCO2 28

Mg: 1.7

CK: 333

TSH: 196.80

The abdominal CT scan demonstrates multiple fluid-filled mildly dilated loops of large bowel with air-fluid levels, some minimally dilated loops of small bowel, and no clear transition point identified which is concerning for developing colonic pseudo-obstruction (Ogilvie Syndrome). There are many predisposing factors that may cause Ogilvie Syndrome including recent surgery, infection, trauma, respiratory failure, cancer, and other metabolic conditions.

Given our patient’s history of hypothyroidism with missed doses of levothyroxine and an elevated TSH her cause of Ogilvie syndrome is most likely hypothyroidism. This is also known as myxedema ileus, a rare entity. Management of myxedema ileus consists of bowel decompression with a nasogastric tube and treatment of the hypothyroid condition. In our case, the patient received 200 mcg of levothyroxine, and 12.5 mcg of liothyronine while undergoing further endocrinologic workup

Take-Home Points

  • In patients with a history of hypothyroidism presenting with gastrointestinal concerns, myxedema ileus, while not common, should be considered.
  • Colonic pseudo-obstruction (Ogilvie syndrome) has many causes and the radiographic appearance of a bowel obstruction without an obvious transition point.
  • Myxedema ileus should be managed with bowel decompression and treatment of the underlying hypothyroidism. ICU level care is often needed for this severe endocrine emergency

  • Saunders MD. Acute colonic pseudo-obstruction. Best Pract Res Clin Gastroenterol. 2007;21(4):671-87. doi: 10.1016/j.bpg.2007.03.001. PMID: 17643908.

  • Vanek VW, Al-Salti M. Acute pseudo-obstruction of the colon (Ogilvie’s syndrome). An analysis of 400 cases. Dis Colon Rectum. 1986 Mar;29(3):203-10. doi: 10.1007/BF02555027. PMID: 3753674.

Copyright

Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2023 SAEM Annual Meeting | Copyrighted by SAEM 2023 – all rights reserved. View other cases from this Clinical Image Series on ALiEM.

By |2025-02-19T12:24:25-08:00Feb 21, 2025|Endocrine-Metabolic, Gastrointestinal, SAEM Clinical Images|
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Diagnosis on Sight: “Stabbing Belly Pain”

A 24-year-old male with a history of microscopic hematuria presented to the emergency department (ED) with left lower quadrant abdominal pain. His pain started about two weeks ago and has been intermittent. He describes the pain as stabbing. He decided to come to the ED today because of the persistent nature of the pain. He denies chest pain, cough, shortness of breath, fevers, nausea, vomiting, diarrhea, constipation, rectal bleeding, dysuria, and increased urinary frequency. His exam revealed a well-appearing male in no acute distress. His abdomen was soft with left lower quadrant tenderness on palpation but no rebound or guarding. A CT Abdomen/Pelvis with IV contrast was obtained with the following images:

Axial view.

Axial View

Coronal View

What is the diagnosis?

Intussusception

Explanation:

Intussusception is a telescoping of a proximal segment of the GI tract into the lumen of the adjacent distal segment of the GI tract.

The axial image of the left side of the abdomen shows a dilated small bowel loop with a target-like appearance, typical of intussusception.  Coronal imaging shows that the intussusception is approximately 4.5 cm long.

Intestinal intussusception is classically a diagnosis associated with childhood. Adult cases of intussusception are quite rare and only account for about 5% of all cases [1]. Only 1-5% of all cases of bowel obstructions are secondary to adult intussusception [1-2].

Etiologies of adult intussusception include [2]:

  • Inflammatory bowel disease
  • Adhesions due to past surgeries
  • Meckel’s diverticulum
  • Benign tumors
  • Malignant tumors
  • Iatrogenic (e.g., intestinal tubes, feeding tubes, gastric surgery)
  • Idiopathic (8-20% of cases)

CT Abdomen/Pelvis is the diagnostic modality of choice [3].

Treatment typically involves surgery with surgical resection. The possibility of a malignant lesion also needs to be assessed.

Case Conclusion:

Surgery was consulted.  The patient’s pain was resolved when they saw the patient in the emergency department.  Therefore, the surgeon did not believe that the patient needed urgent surgery.  However, surgery did recommend a fluoroscopic small bowel series for further evaluation, which ultimately came back unremarkable.  Subsequently, the surgeon’s recommendation was to discharge the patient home with a plan for an outpatient colonoscopy to assess for malignancy.  The colonoscopy was completed only a few days later which only revealed benign polyps.

Want more visual stimulation? Check out the Diagnosis on Sight archives!

References

  1. Marinis A, Yiallourou A, Samanides L, Dafnios N, Anastasopoulos G, Vassiliou I, Theodosopoulos T. Intussusception of the bowel in adults: a review. World J Gastroenterol. 2009;15(4):407.  PMID 19152443.
  2. Zubaidi A, Al-Saif F, Silverman R. Adult Intussusception: A Retrospective Review. Dis Colon Rectum. 2006 Oct;49(10):1546-51. PMID 16990978.
  3. Azar T, Berger DL. Adult intussusception. Ann Surg. 1997;226:134–138.  PMID 9296505.
By |2024-09-18T06:51:17-07:00Sep 25, 2024|Diagnose on Sight, Gastrointestinal, Radiology, Uncategorized|
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SAEM Clinical Images Series: An Unusual Foreign Body

vp shunt

A 61-year-old female with a past medical history of hypertension, hyperlipidemia, type 2 diabetes, and normal pressure hydrocephalus s/p VP shunt (last revision nine months ago) presented to the Emergency Department (ED) for evaluation after noticing a “string” coming out of her anus today. Associated symptoms included nausea and a mild headache for one day, and one episode of vomiting prior to arrival. The patient denied abdominal pain, dizziness, fever, chills, diarrhea, and constipation. She had no other complaints on a complete review of systems. Past surgical history was significant for laparoscopic ventral hernia repair with mesh and lysis of adhesions (three years ago), as well as prior appendectomy, cholecystectomy, c-section, and right nephrectomy.

 

bowel

Vitals: Temp 98.4°F (36.9°C); BP 110/56; HR 64; RR 16; SpO2 100%

General: No acute distress, well appearing.

Neck: Supple, non-tender, no meningismus, full and painless range of motion.

Abdomen: Soft, nontender, nondistended. No peritoneal signs.

Neuro: Awake, alert and oriented x3, no focal neurologic deficits.

Rectum: Narrow lumen tube-like structure protruding from anus. Soft stool present at anus with no blood or melena. Non-tender rectal exam.

Complete Blood Count (CBC): No leukocytosis, no anemia

Comprehensive Metabolic Panel (CMP): Within normal limits

Ventriculoperitoneal shunt erosion into the intestinal tract

Diagnosis can be established with abdominal imaging including VP Shuntogram X-ray series. A CT abdomen/pelvis would also be confirmatory imaging while assisting in ruling out other intra-abdominal complications such as bowel perforation, abscesses or other diseases.

Broad-spectrum empiric antibiotics with CNS coverage should be started for treatment of presumed intra-abdominal, bloodstream, and/or CNS infection. General surgery and neurosurgery should be consulted emergently for evaluation. Bloodwork and a full infectious workup including blood cultures should be done. CSF cultures should be considered as well, in consultation with a neurosurgeon. Patients are at high risk of bacterial spread to the abdomen or retrograde spread up the ventriculoperitoneal shunt leading to peritonitis, peritoneal abscess, ventriculitis, meningitis, or sepsis. Further indicated invasive/surgical interventions should be deferred to general surgery and neurosurgery consultants. Our patient had a confirmatory CT abdomen/pelvis showing the VP shunt catheter perforation into the sigmoid colon and exiting through the rectum. The patient was started on vancomycin, cefepime, and flagyl. General surgery and neurosurgery were consulted and the patient was taken the same day to the OR for laparoscopy and externalization of VP shunt from bowel.

Take-Home Points

  • Bowel perforation is a rare but serious complication of ventriculoperitoneal shunts.
  • Diagnosis should be considered even in patients who present with no meningeal or peritonitic signs.
  • Imaging should be obtained to confirm diagnosis, and broad-spectrum antibiotics with CNS coverage should be started early.
  • General surgery and neurosurgery should be consulted emergently for further operative interventions.

  • Paff, M, Alexandru-Abrams, D, Muhonen, M, Loudon, W. (2018). Ventriculoperitoneal shunt complications: A review. Interdisciplinary Neurosurgery, 13, 66-70.
  • Bales J, Morton RP, Airhart N, Flum D, Avellino AM. Transanal presentation of a distal ventriculoperitoneal shunt catheter: Management of bowel perforation without laparotomy. Surg Neurol Int. 2016 Dec 28;7(Suppl 44):S1150-S1153. doi: 10.4103/2152-7806.196930. PMID: 28194303; PMCID: PMC5299151.

Copyright

Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2023 SAEM Annual Meeting | Copyrighted by SAEM 2023 – all rights reserved. View other cases from this Clinical Image Series on ALiEM.

By |2024-09-06T22:04:47-07:00Sep 9, 2024|Gastrointestinal, Radiology, SAEM Clinical Images|
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