A Benign Case of Hepatic Gas

[摘要] A 33-year-old obese male with a history of well-controlled type II diabetes and hyperlipidemia presented to the emergency department with a one-day history of recurrent non-bloody diarrhea and abdominal pain in the morning progressing to significant nausea, increased non-radiating abdominal pain, and multiple episodes of non-bilious, non-bloody emesis in the evening. The patient reported 8/10 non-radiating, sharp, epigastric abdominal pain upon arrival. Physical examination findings revealed tenderness and rigidity in the right lower quadrant. The patient had an initial white blood cell count of 22.9 cells/millimeter3 (mm3) anion gap of 16 milliequivalents per liter (L), glucose level of 203 millimoles per liter (mmol/L), and a lactate of 3.01mmol/L. A computed tomography (CT) of abdomen and pelvis with intravenous contrast showed a mild wall thickening of the terminal ileum with multiple reactive mesenteric lymph nodes in the right lower quadrant indicative of inflammation, and a small volume of hepatic gas in the left hepatic lobe (Image). Point-of-care ultrasound of the abdomen confirmed the presence of hepatic gas in the left hepatic lobe (Video). The patient received two L of normal saline and was reevaluated showing significant pain relief. Ciprofloxacin, metronidazole, and vancomycin were given to treat an infectious etiology causing terminal ileum inflammation and diarrhea. The patient was admitted with gastroenteritis and subsequently discharged.

[学科分类] 医学（综合）