Case 31-2009 -- A 26-Year-Old Man with Abdominal Distention and Shock

doi:10.1056/NEJMcpc0900643

Volume 361:1487-1496		October 8, 2009		Number 15

Case 31-2009 — A 26-Year-Old Man with Abdominal Distention and Shock

Hasan B. Alam, M.D., Gregory L. Fricchione, M.D., Alexander S.R. Guimaraes, M.D., Ph.D., and Lawrence R. Zukerberg, M.D.

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Presentation of Case

Dr. Jeffrey S. Ustin (Trauma, Emergency Surgery, and SurgicalCritical Care): A 26-year-old man was admitted to this hospitalbecause of abdominal distention and shock.

The patient had been well until the evening before admission,when mild abdominal pain developed, shortly after he had eatenfive or six frankfurters. The pain gradually increased overnight,and nausea developed the next day. In the evening of the dayof admission, his parents found him unresponsive, with coffee-groundsmaterial emanating from his mouth. They called emergency medicalservices. On examination, he was obtunded, with agonal respirations.The trachea was intubated without medications, and . . . [Full Text of this Article]

Differential Diagnosis

The Lethal Triad and Damage-Control Surgery

Early, Goal-Directed Resuscitation

Dr. Hasan B. Alam's Diagnosis

Pathological Discussion

Acute Megacolon (Ogilvie's Syndrome)

Clozapine-Induced Gastrointestinal Hypomotility

Discussion of Management

Anatomical Diagnosis

Source Information

From the Departments of Surgery (H.B.A.), Psychiatry (G.L.F.), Radiology (A.S.R.G.), and Pathology (L.R.Z.), Massachusetts General Hospital; and the Departments of Surgery (H.B.A.), Psychiatry (G.L.F.), Radiology (A.S.R.G.), and Pathology (L.R.Z.), Harvard Medical School.