Clinical Cases & Journal Review

Bradley Phillips A 47-year-old female with a medical history of right nephrectomy complicated by incisional “Swiss cheese” ventral hernias with recurrent incarceration and bowel strangulation presented to the ED with acute abdominal pain localized to the ventral hernia, nausea, and vomiting. About three years earlier, the patient had undergone an exploratory laparotomy while admitted for peritonitis, which revealed an ischemic segment of small bowel and incarcerated omentum within a ventral hernia. She then underwent omentectomy, small bowel resection with primary anastomosis, and ve...

Kayhon Rabbani A 22 year old male who has no past medical history presented with a 3 day history of viral URI-like symptoms with sore throat, dry cough, shortness of breath, and dyspnea on exertion. The patient was an active marine recruit with many other members in his company being sick during this time. Shortly prior to arrival, the patient became unable to walk short flights of steps without becoming short of breath. The patient otherwise had no respiratory or cardiac history. He had no family history of sudden cardiac death or early MI. The patient denied fevers, chills, chest pain, pl...

Kanchi Mehta A 38yo male with history of diverticulitis complicated by sepsis presented to the ED with lower quadrant abdominal pain. He noted that the pain started 2 weeks ago and became worse. He reported normal bowel movements in the morning, denied fever/chills, nausea, vomiting, or genitourinary symptoms. A recent colonoscopy was notable for moderate sigmoid diverticulosis and a 4mm sessile sigmoid polyp that was resected. Past medical history: Diverticulitis, ADHD, eczema, insomnia, loose stools No past surgical history. Vitals: BP 107/65 | Pulse 73 | Temp 98 °F (36.7 °C) |...

Cloie June Chiong A 37 year old male with a past medical history of ulcerative colitis, now status-post total abdominal colectomy with a creation of end ileostomy, left-sided ureteral lysis due to retroperitoneal fibrosis, robotic-assisted proctectomy with creation of an ileoanal pouch and diverting loop ileostomy, extensive lysis of adhesions and right-sided ureterolysis, and ileostomy takedown in 2024 presents to the ED with diffuse abdominal pain that began this morning and sweats beginning last night. The pain was 4/10 with rest, 7/10 with standing, and 8/10 with ambulation. The pain ra...

Alma Fregoso Leyva 73 year old male with a past medical history of coronary artery disease, congestive heart failure, COPD, pulmonary fibrosis on 5L NC, and left lower extremity prosthetic joint infection s/p total femur replacement presented via EMS with 3 days of worsening left lower leg pain and swelling. He reported pain around the left lower leg down to the foot. His symptoms were associated with chills and fatigue. He reported compliance with Eliquis.  Vitals: BP 92/80, Pulse 100, Temp 98.1 F, RR 11, SpO2 93% on 5L NC  Physical Exam:- General: A&O x4- Cardiac: RRR- Lu...

Teini Elisara Case An 82 year old female with a past medical history of anemia of chronic disease, breast cancer, diabetes mellitus, hypertension, osteoporosis, rectal adenocarcinoma, scleroderma with pulmonary involvement, and systemic lupus erythematosus presented to the emergency department after a mechanical fall the night prior. She was getting into bed when she tripped and fell on the left side of her body landing on her left arm and hitting the side of her head on the floor. Patient endorsed severe pain to her left wrist. Vitals: BP 162/64 | Pulse 67 | Temp 98 °F (36.7 °C) | ...

Josh Gieschen Case: 32yo male with no PMH who presents following a fall down the stairs with no head strike or loss of consciousness. He endorses left shoulder pain and inability to range his left shoulder. He has never dislocated his shoulder before. His pain is 8/10 and limited to the L shoulder, worse with motion or palpation. Vitals:  Temp 97.6 °F | HR 87 | RR 18 | BP 119/76 | SPo2 100% on RA Physical Exam: L arm held internally rotated, flexed, and guarded closely to torso. An obvious step-off deformity was seen directly lateral to glenoid with increased prominence of th...

Molly Chou An 83-year-old male presented to our emergency department with shortness of breath. He woke up that morning with symptoms and called EMS. On arrival, the patient was alert and oriented with SpO2 90% on room air. The patient had a recent admission for right middle and lower lobe pneumonia. He also reported a history of heart failure with mildly reduced ejection fraction, coronary artery disease, and chronic kidney disease. Vitals: BP 122/71, HR 92, RR 30, T 98.8F, spO2 90% on room air, 99% on 4LNC Exam: Normal heart sounds, tachypnea, rhonchi in bilateral lower lobes, non-te...

Alex Liang, Rachna Subramony A 48 year old male with past medical history of Crohn’s Disease, cryptogenic cirrhosis, pancytopenia, portal vein thrombosis, Factor V Leiden, and prior history of kidney stones presenting with right sided flank pain, dysuria, and hematuria worsening over the past 4 days. He reports similar symptoms in the past associated with his previous findings of kidney stones. He denies fever, nausea, vomit, diarrhea, chest pain, shortness of breath, or anuria. Vitals: BP 123/80 mmHg | Pulse: 101 | Temp: 98.5 °F (36.9 °C) | Resp: 20 | Wt: 65.8 kg (145 lb) | SpO2: 97...

Skyler Sloane, Benjamin Supat, Colleen Campbell An 83-year-old man presented to the emergency department with a chief complaint of acute onset lower abdominal pain radiating to the right groin. The patient reported a history of hypertension, coronary artery disease, and nephrolithiasis.  Vitals: BP 71/51 | Pulse 84 | Temp 98.0 °F (36.6 °C) | Resp 20 | SpO2 99% on RA  On physical exam, the patient appeared to be in obvious discomfort. There was diffuse abdominal tenderness though no rebound or guarding was observed. A bedside FAST exam was performed. What do you see?&nbs...