Crosby Jill, Werku Dagmawi, Zewdu Tigist, Wanjiku Grace, Schmidt Jessica
Department of Emergency Medicine, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792, USA.
Department of Emergency Medicine, Black Lion Hospital, Addis Ababa, Ethiopia.
Afr J Emerg Med. 2018 Dec;8(4):164-166. doi: 10.1016/j.afjem.2018.08.002. Epub 2018 Oct 2.
The term refers to a clinical syndrome of sudden onset, severe abdominal pain. The differential diagnosis for this presentation is broad, but most cases require emergent medical or surgical management. Especially in cases of ischaemic bowel, time to diagnosis can mean the difference between survival and death. As a result, mortality remains high in resource-limited settings.
We describe the case of a 28-year-old male who presented to an urban Ethiopian emergency centre with three days of vomiting, bloody diarrhoea, and abdominal pain. He collapsed in triage with weak pulses and an undetectable blood pressure. Point-of-care ultrasound revealed a hyperechoic, mobile mass in the left ventricle of the heart. Small bowel dilation and thickening was visualised throughout the abdomen. Mesenteric ischaemia was rapidly identified as the working diagnosis, prompting early surgical consultation and aggressive, goal-directed resuscitation.
Short of elucidating a definitive diagnosis, ultrasound narrowed the focus of an undifferentiated presentation and supported mobilisation for exploratory laparotomy. Ultimately, this circumvented several hours of time which is conventionally required to obtain computed tomography at this institution. As demonstrated in this case, point-of-care ultrasound can be life-saving in resource-limited settings where acquisition time for definitive imaging is often prohibitive.
该术语指的是一种突发的、严重腹痛的临床综合征。这种表现的鉴别诊断范围广泛，但大多数病例需要紧急的医学或外科处理。特别是在缺血性肠病的病例中，诊断时间可能意味着生死之别。因此，在资源有限的环境中死亡率仍然很高。
我们描述了一名28岁男性的病例，他因三天的呕吐、血性腹泻和腹痛就诊于埃塞俄比亚城市的一家急诊中心。他在分诊时晕倒，脉搏微弱且血压测不出。床旁超声显示心脏左心室有一个高回声的活动团块。整个腹部可见小肠扩张和增厚。肠系膜缺血迅速被确定为初步诊断，促使早期进行外科会诊并积极进行目标导向的复苏。
在未明确诊断的情况下，超声缩小了未分化表现的关注范围，并支持进行剖腹探查术。最终，这节省了在该机构通常获取计算机断层扫描所需的几个小时时间。如本病例所示，在资源有限的环境中，床旁超声可能是救命的，因为获取确定性成像的时间往往过长。
