4.4 of 9 Ratings
A 5 day old neonate presents at night to the emergency room with "one day of green vomiting and a larger belly than usual" according to mom. The mother explains that the patient passed stool for only two days after birth and had been feeding well until this morning when the patient vomited after feeding and continued to vomit sporadically throughout the day. Newborn screening was normal for this patient, there were no pregnancy complications, the patient has been breastfeeding consistently with only some regurgitation, and the patient has no sick contacts. The abdomen is distended on physical exam without palpable masses, and there is no stool in the rectal vault. Upper gastrointestinal series film can be appreciated in Figure A. What is the most likely diagnosis of this patient?
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A 73-year-old woman with a history of diabetes presents to the emergency department with severe abdominal pain and constipation for 24 hours. Vital signs are T: 100.3 F, HR: 80 bpm, BP: 143/82 mmHg, RR: 24/min, O2 Sat: 95%. Abdominal exam is notable for diffuse abdominal tenderness to palpation, without rebound or guarding. Laboratory studies are notable for leukocytosis, though lactic acid is within normal limits. Abdominal x-ray is shown in Figure A. Which of the following are the best next management steps for this patient?
Sigmoidoscopy and placement of a rectal tube for 48-72 hours
Barium Enema with abdominal xray
Immediate laparotomy with Hartmann's procedure
Immediate laparotomy with sigmoidectomy and primary anastomosis
NPO, NG tube decompression and neostigmine
A 74-year-old female presents to the emergency room with abdominal pain. She notes several days of constipation and most recently has not had a bowel movement in 3 days. She is unable to remember if she has passed gas. Her vital signs are BP 118/76 mmHg, HR 97 beats per minute, RR 17 breaths per minute, and T 99.4 degrees Fahrenheit, and her abdomen is noticeably distended. A barium enema radiograph is shown in Figure A. Which of the following is the best next step?
Manual evacuation of rectal impaction
Administer large doses of laxatives
Laparotomy with sigmoid resection
Proctosigmoidoscopy and placement of a rectal tube