scholarly journals Ovarian Torsion in the Normal Ovary: A Diagnostic Challenge in Postmenarchal Adolescent Girls in the Emergency Department

2017 ◽  
Vol 23 ◽  
pp. 1312-1316 ◽  
Author(s):  
Erbil Karaman ◽  
Burhan Beger ◽  
Orkun Çetin ◽  
Mehmet Melek ◽  
Yasemin Karaman
Keyword(s):  
Emergency Department ◽  
Adolescent Girls ◽  
Ovarian Torsion ◽  
Normal Ovary ◽  
Diagnostic Challenge

A Rare Case of Bilateral Incarcerated Obturator Hernias and a Right-Side Femoral Hernia

2020 ◽  
pp. 1-3
Author(s):  
Jinping Xu ◽  
Jinping Xu ◽  
Ruth Wei ◽  
Salieha Zaheer
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Femoral Hernia ◽  
Rare Case ◽  
Hernia Recurrence ◽  
High Morbidity ◽  
Diagnostic Challenge ◽  
Abdominal Ct ◽  
Abdominal Ct Scan ◽  
History Of

Obturator hernias are rare but pose a diagnostic challenge with relatively high morbidity and mortality. Our patient is an elderly, thin female with an initial evaluation concerning for gastroenteritis, and further evaluation revealed bilateral incarcerated obturator hernias, which confirmed postoperatively as well as a right femoral hernia. An 83-year-old female presented to the outpatient office initially with one-day history of diarrhea and one-week history of episodic colicky abdominal pain. She returned 4 weeks later with diarrhea resolved but worsening abdominal pain and left inner thigh pain while ambulating, without changes in appetite or nausea and vomiting. Abdominal CT scan then revealed bilateral obturator hernias. Patient then presented to the emergency department (ED) due to worsening pain, and subsequently underwent hernia repair. Intraoperatively, it was revealed that the patient had bilateral incarcerated obturator hernias and a right femoral hernia. All three hernias were repaired, and patient was discharged two days later. Patient remained well postoperatively, and 15-month CT of abdomen showed no hernia recurrence.

scholarly journals Emergency Department and Radiological Cost of Delayed Diagnosis of Cannabinoid Hyperemesis

2019 ◽  
Vol 2019 ◽  
pp. 1-4 ◽  
Author(s):  
David I. Zimmer ◽  
Ross McCauley ◽  
Varun Konanki ◽  
Joseph Dynako ◽  
Nuha Zackariya ◽  
...  
Keyword(s):  
Emergency Department ◽  
Delayed Diagnosis ◽  
The United States ◽  
Clinical Syndrome ◽  
Cannabis Use ◽  
Diagnostic Challenge ◽  
High Clinical Suspicion ◽  
Ed Visits ◽  
Inappropriate Utilization ◽  
Utilization Of Healthcare

Background. Chronic cannabis use has become prevalent with decriminalization, medical prescription, and recreational legalization in numerous US states. With this increasing incidence of chronic cannabis use a new clinical syndrome has become apparent in emergency departments and hospitals across the country, termed Cannabinoid Hyperemesis (CH). CH has been described as cyclical vomiting and abdominal pain in the setting of chronic cannabis use, which is often temporarily relieved by hot showers. CH presents a diagnostic challenge to clinicians who do not have a high clinical suspicion for the syndrome and can result in high costs and resource utilization for hospitals and patients. This study investigates the expenditures associated with delayed CH evaluation and delayed diagnosis. Methods. This is a retrospective observational study of 17 patients diagnosed with CH at three medical centers in the United States from 2010 to 2015, consisting of two academic centers and a community hospital. Emergency department (ED) costs were calculated and analyzed for patients eventually diagnosed with CH. Results. For the 17 patients treated, the total cost for combined ED visits and radiologic evaluations was an average of $76,920.92 per patient. On average these patients had 17.9 ED visits before the diagnosis of CH was made. Conclusion. CH provides a diagnostic challenge to clinicians without a high suspicion of the syndrome and may become increasingly prevalent with current trends toward cannabis legalization. The diagnosis of CH can be made primarily through a thorough history and physical examination. Awareness of this syndrome can save institutions money, prevent inappropriate utilization of healthcare resources, and save patients from unnecessary diagnostic tests.

scholarly journals Ovarian Torsion in a 5-Year Old: A Case Report and Review

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Matthew F. Ryan ◽  
Bobby K. Desai
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Case Report ◽  
Urinary Tract ◽  
Clinical Suspicion ◽  
Ovarian Torsion ◽  
Surgical Emergencies ◽  
High Clinical Suspicion ◽  
Tract Infections ◽  
Prompt Diagnosis

Ovarian torsion represents a true surgical emergency. Prompt diagnosis is essential to ovarian salvage, and high clinical suspicion is important in this regard. Confounding the diagnosis in general are more commonly encountered abdominal complaints in the Emergency Department (ED) such as constipation, diarrhea, and urinary tract infections and more common surgical emergencies such as appendicitis. Prompt diagnosis can be further complicated in low-risk populations such as young children. Herein, we describe the case of a 5-year-old girl with a seemingly benign presentation of abdominal pain who was diagnosed in the ED and treated for acute ovarian torsion after two prior clinic visits. A brief discussion of evaluation, treatment, and management of ovarian torsion follows.

scholarly journals Acute binocular diplopia: peripheral or central?

2020 ◽  
Vol 267 (S1) ◽  
pp. 136-142
Author(s):  
Olympia Kremmyda ◽  
Claudia Frenzel ◽  
Katharina Hüfner ◽  
Nicolina Goldschagg ◽  
Christian Brem ◽  
...  
Keyword(s):  
Emergency Department ◽  
Motor Nerve ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Screen Test ◽  
Ocular Motor ◽  
Diagnostic Challenge ◽  
Ocular Motor Disorders ◽  
Visual Vertical ◽  
Binocular Diplopia

Abstract Objectives Acute diplopia is a diagnostic challenge for clinicians, in particular in the emergency department. The most common cause of acute diplopia are ocular motor nerve palsies (OMP). In this prospective study, we focused on identifying the most crucial signs and symptoms for differentiating between peripheral and central OMP. Methods We prospectively evaluated 56 non-consecutive patients who presented at our emergency department with acute binocular diplopia (≤ 10 days). The patient history was taken using a standardized questionnaire and patients underwent a neurological, neuro-ophthalmological and neuro-otological examination, including measurement of the subjective visual vertical (SVV), Harms tangent screen test, and cranial MRI. Results Forty-six out of 56 patients were diagnosed with an ocular motor cranial nerve palsy (OMP), 21 of peripheral and 23 of central origin; in two patients, the etiology remained unknown. The following features were different in peripheral and central OMP: (1) the presence of vertigo/dizziness was more frequent in central (43.5%) than in peripheral (9.5%) OMP. (2) Central ocular motor signs, such as saccadic smooth pursuit, additional internuclear ophthalmoplegia, skew deviation, and saccade palsies, were also found more frequently in the central than in the peripheral group (86.7% vs. 33.3%). (3) Further, a pathological SVV deviation by monocular testing of the non-affected eye was also more common in central (77.3%) than in peripheral OMP (38.9%). The presence of all three factors has a positive predictive value of 100% (CI 50–100%) for the presence of a central lesion. Conclusions In acute diplopia due to central OMP, the most important accompanying symptom is vertigo/dizziness, and the most important clinical signs are central ocular motor disorders (which require examination of the non-paretic eye) and an SVV deviation in the non-paretic eye.

EMERGENCY DEPARTMENT UTILIZATION FOR OVARIAN TORSION IN THE UNITED STATES (2006-2016)

2020 ◽  
Vol 114 (3) ◽  
pp. e110
Author(s):  
Jessie-Joyce Kue ◽  
Charley Jiang ◽  
Emma Giuliani ◽  
Chelsea N. Fortin ◽  
Erica E. Marsh
Keyword(s):  
United States ◽  
Emergency Department ◽  
The United States ◽  
Ovarian Torsion ◽  
Emergency Department Utilization

Isquemia intestinal por trombosis mesentérica en paciente geriátrico, resuelta por intervencionismo. Reporte de caso

2020 ◽  
Vol 63 (2) ◽  
pp. 24-32
Author(s):  
Bianca Eunice López Zenteno ◽  
Georgina Cornelio Rodríguez ◽  
Eduardo Amador Mena
Keyword(s):  
Emergency Department ◽  
Intestinal Ischemia ◽  
Clinical Case ◽  
Clinical Presentation ◽  
Imaging Study ◽  
Clinical Suspicion ◽  
Imaging Diagnosis ◽  
Diagnostic Challenge ◽  
Mesenteric Thrombosis ◽  
Diagnostic Imaging Study

Mesenteric thrombosis represents a vascular urgency caused by the abrupt interruption of blood flow, whether arterial or venous; clinical presentation can be nonspecific, which can represent a diagnostic challenge. According to its vascular etiology, a different therapeutic approach is required. If there is clinical suspicion or signs of peritonitis, the imaging diagnosis can support to identify the presented pathology. On this occasion, there is a clinical case of an 84-year-old http://doi.org/10.22201/fm.24484865e.2020.63.2.04 | Vol. 63, n.o 2, Marzo-Abril 2020 25 patient who goes to the emergency department for generalized abdominal pain, which led to a diagnostic imaging study, to confirm this finding. Key words: Intestinal ischemia; atherosclerosis; Mesenteric thrombosis; catheterization

Pediatric Hematologic Emergencies

2020 ◽  
pp. 311-326
Author(s):  
Jacquelyn Baskin ◽  
Jeranil Nunez
Keyword(s):  
Emergency Department ◽  
Sickle Cell Disease ◽  
Physical Examination ◽  
Diagnostic Criteria ◽  
Laboratory Evaluation ◽  
Evidence Based ◽  
Diagnostic Challenge ◽  
Treatment Algorithms ◽  
Detailed History ◽  
Atypical Presentations

Children often present to the emergency department for evaluation of a variety of hematologic complaints ranging from pallor to bruising and bleeding. Some may require emergent evaluation and treatment, whereas others pose more of a diagnostic challenge. A detailed history and physical examination along with laboratory evaluation can aid in appropriate diagnosis and management of these patients. Hematologic emergencies include anemia, disorders of clotting, and sickle cell disease. This chapter reviews common presentations of many pediatric hematologic conditions, atypical presentations, and important diagnostic criteria. In addition, the chapter presents evidence-based treatment algorithms. Potential complications of various conditions are also discussed.

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