Medicine Comes in Handy July 19, 2008

One of my patients had ovarian torsion (yeah, testicles aren’t the only ones that torse), and was on POD #2.  She was doing well, had passed flatus, tolerated a regular diet and was off of the PCA.  Then all of a sudden she started having high volume bilious vomitus.  We decided to make her NPO (nothing by mouth, i.e. no food/liquids) and get an abdominal series.  The film came back and I recognized it immediately.  My chief was like, “I can’t read abdominal films” and same with my attending!  I then proceeded to tell them that it was pretty classic for a small bowel obstruction with the air-fluid levels, dilated loops of small bowel, and a paucity of gas in the colon and pelvis.  They decided to go ahead and wait for the official radiology read and guess what they said… Small Bowel Obstruction!  I was so happy that I was correct, too bad my resident took 4 hours to wait for the read.  We ended up going back to see the patient and she had vomited again.  We ordered a nasogastric tube for her and she is feeling better.  I really hope that this clears up with conservative management cause I’d hate for her to have to go back to the OR.  Here are some examples of what her films looked like (sampled from google):

 

I’m thankful for medicine right now!  During orientation we literally had a 2 hour radiology session on differentiating small bowel obstruction, from large bowel obstruction, from ileus.  It really came in handy today, which was a benefit for the patient.  On top of it all, I impressed my chief who was telling everyone that I made the diagnosis!  Whoever said medical students can’t contribute to the team?  Alot of times we are closer to this knowledge than people who specialize.