The Case Files: An Atypical Quarter Ingestion

By Brian Ault, DO; Rudolph Baldeo, MD; Martin Winick, MD; Ronald Dvorkin, MD; David Levy, DO   A 5-year-old boy presented to the ED with three days of progressive abdominal pain. He had been afebrile with nonbloody, nonbilious vomiting, decreased oral intake, and resultant decreased urination. He was not taking any prescribed medications, nor was he given any medications for his symptoms.       His initial vital signs were blood pressure 102/70 mm Hg; heart rate 130 beats per minute; SpO2 100% on room air; respiratory rate 22 breaths per minute; temperature 36.8°C orally. He looked well and was interactive, playful, and in no distress. His mucous membranes were dry, and his eyes appeared slightly sunken. His abdomen was soft and nontender, and he had normal bowel sounds. His exam was significant for a mobile, nontender 1 cm round mass, 2 cm above the umbilicus. Blood work and an abdominal ultrasound were unremarkable. An abdominal x-ray was ordered because of the patient's vomiting in the ED, and it revealed a metallic density in the small intestine with bowel dilated proximal to it, which was consistent with a small bowel obstruction. The patient's brother then admitted to witnessing the ingestion of a quarter one week earlier. A nasogastric tube was placed, the patient was admitted, and gastroenterology and surgery were consulted. A PO trial using a bowel preparation was given. The patient did not tolerate the prep and the coin remained in the same location, s...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research