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Terrence H. Liu, MD; John R. Mehall, MD; David W. Mercer, MD
[+] Author Affiliations

From the Department of Surgery, The University of Texas[[ndash]]Houston Medical School and Lyndon B. Johnson General Hospital, Houston.


Section Editor: S. Rozycky Grace, MD

More Author Information
Arch Surg. 2001;136(12):1437-1438. doi:.
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Published online

A 15-YEAR-OLD GIRL with Down syndrome and severe developmental retardation came to the hospital with nausea and intractable vomiting of 24 hours' duration. The patient's initial examination results were unremarkable except for minimal abdominal tenderness. Her white blood cell count was 11 000/mm3. A nasogastric tube was placed with the return of "coffee-ground" material and the tube was subsequently removed. She was admitted to the hospital with the presumptive diagnoses of viral gastroenteritis and Mallory-Weiss tear. During the subsequent 16 hours, the patient developed progressively worsening tachycardia, tachypnea, fever, and generalized abdominal pain, which prompted an evaluation by the surgical team. During the initial surgical consultation, she was noted to have a temperature of 39.5°C, a heart rate of 136 beats per minute, and her blood pressure was 100/63 mm Hg. Physical examination of the abdomen revealed diffused abdominal tenderness with generalized peritoneal irritation. The abdominal and chest radiograph films obtained at that time are shown in Figure 1and Figure 2.

WHAT IS THE MOST LIKELY DIAGNOSIS?

A. Gastric volvulus

B. Boerhaave syndrome

C. Cecal volvulus

D. Acute gastric dilatation with necrosis

Corresponding author and reprints: Terrence H. Liu, MD, Department of Surgery, University of Texas–Houston Medical School, 5656 Kelley St, Suite 30S 62 008, Houston, TX 77026-1967 (e-mail: terrence.h.liu@uth.tmc.edu).

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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