J Korean Soc Emerg Med.  2013 Jun;24(3):309-312.

Bedside Ultrasound for the Diagnosis of Bowel Necrosis in a Patient with an Altered Mental Status

• Kim KD
• Ryu S
• Ahn HJ
• Cho YC

Abstract

Bowel necrosis generally requires an immediate operation and causes a high mortality rate. Unfortunately, in patients with altered consciousness, diagnosis can be very difficult. In our case, a 45-year-old male, with an altered mentality due to brain injury (from head trauma) and alcohol intoxication, was brought into our emergency department. Due to his altered state, he had no initial complaints about any other symptoms besides a headache. After a physical examination, no other signs were observed, except for swelling on the head. However, a worsening of wide anion gap metabolic acidosis was observed upon laboratory examination. A bedside ultrasound was performed to evaluate the reason for this metabolic acidosis, and pneumatosis intestinalis and hepatic portal venous gas was observed. Eventually bowel necrosis was diagnosed, an emergency operation was executed, and the patient recovered.

Keyword

Pneumatosis intestinalis; Portal venous gas; Ultrasonography

MeSH Terms

Acid-Base Equilibrium
Acidosis
Brain Injuries
Consciousness
Diagnosis*
Emergencies
Emergency Service, Hospital
Head
Headache
Humans
Male
Middle Aged
Mortality
Necrosis*
Physical Examination
Ultrasonography*