Ogilvie syndrome, also known as “paralytic ileus of the colon,” is characterized by pseudo- obstruction of the colon without any component of mechanical obstruction; and presents as a massively distended abdomen. If left untreated, it carries a high risk of colonic perforation and ischemia leading to death. Ogilvie syndrome usually presents as a post-surgical complication, mainly due to the lack and/or restriction of movement coupled with a possible electrolyte imbalance. In this case, the patient was a non-surgical candidate who presented with a hip fracture after a mechanical fall. Three days post-fall, she developed nausea, abdominal discomfort, and constipation during her hospitalization, which gradually resulted in a massively distended abdomen. The patient was managed conservatively with a nasogastric tube, rectal tube decompression, Metoclopramide, and Magnesium Citrate administration. Abdominal X-rays showed massively dilated bowel loops. An abdominal CT scan showed diffuse dilation of the large bowel without a transition point, suggesting obstruction favoring colonic paralytic ileus. She was discharged to a rehabilitation facility for further physical therapy.
Acute pulmonary embolism (PE) is when one or more thrombus travel to the lungs and obstruct the pulmonary artery or one of the branches of the pulmonary tree, producing signs and symptoms immediately after the obstruction. Saddle pulmonary embolism (SPE) is a rare type of acute PE that can lead to hemodynamic instability and death. The incidence of pulmonary embolism increases with age. In women, the risk of PE increases with pregnancy, hormonal contraceptives, and hormone replacement therapy. In this case, the patient was in her forties and presented with a sudden episode of continuous dyspnea that worsened over four hours. The dyspnea was associated with palpitations and diaphoresis. The clinical scoring tools had a low pre-test probability for PE. The patient had no risk factors for PE other than being obese. Significant laboratory workup showed troponin of 0.10, D-dimer of 8.10, and a B-type natriuretic peptide (BNP) of 1,160. Her computed tomography angiography (CTA) showed extensive pulmonary emboli in the bilateral main and segmental pulmonary arteries, with findings consistent with right heart strain. The patient was managed with an unfractionated heparin loading dose in the ED based on her weight, followed by a heparin drip. Then, the patient was transferred to a tertiary medical center for further interventions. Prompt recognition and treatment of a submassive PE are fundamental to improving patient mortality and morbidity.
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