Not what was expected ... but what was?

Posted by Dan Crompton

This 31 year old female presented at 12:30 to a sub-tertiary emergency department. Brought in by ambulance complaining of feeling generally unwell with chest and abdominal pains. She had seen her GP a week prior and was diagnosed with influenza.

Further history revealed having fevers and sweats and she denied opening her bowels for 2 days and had pain in the RIF. She denied vomiting, previous PID and pregnancy.

​Her observations on arrival were:

P 140              BP123/70             RR 20               Sa O2 98% - room air
Temp 38.5              GCS 14 (V4)

PMH
IVDU - currently using - Ice and amphetamines
Renal Failure - undifferentiated
Pancreatitis
Cholecystectomy
Bipolar disorder
Personality disorder
Chronic chest pain following MVA 10 years ago

Triaged Category 3 and assigned to a cubicle. She was seen by a doctor 105 minutes after arriving.

On exam she had stigmata of recent IVDU. Abdomen was "soft" with tenderness in the right iliac fossa and hypochondrium.

​As part of her initial work-up she had an abdominal x-ray requested "tro SBO".

What is the utility of a plain abdominal film in a patient with sepsis?
What abnormality does the image show?

Answer next week.

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