Case of the week 8.5.24
Publication Date: 2024-08-01
3 images
Findings
The serosal detail is within normal limits. There are 4 nerf bullets in the GI tract. 2 of them are in the colon. 2 of them are in the small intestines. Only the rubbery part of the bullet is present, and only one is complete, otherwise only the very tip of the bullet is present. There is moderate dilation of the stomach with gas and fluid. The small intestines are fluid filled primarily with mild gas dilation. The remainder of the abdomen is otherwise unremarkable.
Diagnosis
Nerf bullets in the GI tract. Two in the large intestines, two in the small intestines. The dilation of the stomach and small intestines is concerning for mechanical obstruction, at least partial in nature. However the presence of two bullets in the colon might indicate that normal voiding might be possible. Repeat abdominal radiographs and/or abdominal ultrasound could be considered in 8-12h, or sooner if the patient deteriorates/does not improve, for further evaluation if clinically indicated. Alternatively surgical explore could be considered if clinically indicated.
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