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J Korean Soc Emerg Med > Volume 24(3); 2013 > Article
Journal of The Korean Society of Emergency Medicine 2013;24(3): 309-312.
Bedside Ultrasound for the Diagnosis of Bowel Necrosis in a Patient with an Altered Mental Status
Kun Dong Kim, Seung Ryu, Hong Joon Ahn, Yong Chul Cho
Department of Emergency Medicine, School of Medicine, Chungnam National University, Daejeon, Korea. rs0505@cnuh.co.kr
ABSTRACT
Bowel necrosis generally requires an immediate operation and causes a high mortality rate. Unfortunately, in patients with altered consciousness, diagnosis can be very difficult. In our case, a 45-year-old male, with an altered mentality due to brain injury (from head trauma) and alcohol intoxication, was brought into our emergency department. Due to his altered state, he had no initial complaints about any other symptoms besides a headache. After a physical examination, no other signs were observed, except for swelling on the head. However, a worsening of wide anion gap metabolic acidosis was observed upon laboratory examination. A bedside ultrasound was performed to evaluate the reason for this metabolic acidosis, and pneumatosis intestinalis and hepatic portal venous gas was observed. Eventually bowel necrosis was diagnosed, an emergency operation was executed, and the patient recovered.
Key words: Pneumatosis intestinalis, Portal venous gas, Ultrasonography
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