Today's X-Ray Mysterie
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The X-Ray:
The CT Scan:
The Story (yeah, it's an old story, but holeee crap!):
The Perils of Competitive Speed Eating!
A 30-year-old, healthy man presented to the emergency department with abdominal pain and distension 8 hours after a competitive speed eating event where the patient consumed a 3.2-kg burger in 30 minutes. This was associated with vomitus that was nonbloody and nonbilious, comprising undigested food materials. Clinical examination revealed a tense and distended abdomen, but no pneumoperitoneum was noted on the initial chest radiograph (Figure A). Blood investigations showed elevated total white counts (25 × 109/L), serum creatinine (150 μmol/L), and serum amylase (501 U/L). He also had metabolic acidotic with a lactate of 5 mmol/L and base excess of -6 mmol/L.
A computed tomography scan of the abdomen and pelvis was performed, which showed the stomach and proximal duodenum being grossly distended with food material (Figure B) and an abrupt caliber change at the third part of the duodenum (Figure C). The pancreas was compressed and the bowels were pushed to the left iliac fossa (Figure D). The patient was monitored in the general ward and regular gastric lavages through the nasogastric tube were performed in an attempt to decompress the distended stomach. Despite the lavages, the patient’s symptoms persisted. Plans for an open gastrostomy to evacuate the undigested food particles were abandoned when the patient started to pass flatus and there was resolution of metabolic acidosis and elevated white counts. Eventually, the patient managed to move his bowels and was discharged well 5 days later. -
