It's Not Cyclic Vomiting Syndrome Until Dietl's is Ruled Out: A Case for Point of Care Renal Ultrasound

IF 1.2 4区 医学 Q3 EMERGENCY MEDICINE
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Abstract

Background

Abdominal pain and vomiting are frequent complaints for pediatric patients presenting to the Emergency Department (ED). When a diagnosis such as chronic abdominal pain, cyclic vomiting, or abdominal migraine has previously been made, it can lead to diagnostic momentum and confirmation bias on behalf of the treating physician. Dietl's crisis is a commonly missed diagnosis in the pediatric population that presents with intermittent episodes of pain and vomiting. It can be readily diagnosed at the bedside by the emergency physician (EP) through the employment of point of care ultrasound (POCUS).

Case Series

We present two cases of pediatric patients with episodic abdominal pain and vomiting who were previously diagnosed with cyclic vomiting syndrome. In both cases, pediatric gastroenterology evaluations had occurred with negative diagnostic testing having been performed. Both patients also presented to their primary pediatrician and the ED multiple times with each encounter resulting in treatment of symptoms and discharge. Each patient eventually presented to the ED when an EP was present who performed a renal POCUS. In each patient, the POCUS revealed severe unilateral hydronephrosis. Subsequent workup confirmed the diagnosis of Dietl's crisis as the etiology of symptoms.

Why Should an Emergency Physician Be Aware of This?

In pediatric patients, EPs should be wary of the diagnosis of cyclic vomiting syndrome until ureteral obstruction has been ruled out. A bedside POCUS can rapidly establish this diagnosis and potentially preclude recurrent health care visits, unnecessary diagnostic testing, and permanent loss of renal function.

"在排除迪特尔综合征之前,这不是周期性呕吐综合征:肾脏超声检查的案例"
背景腹痛和呕吐是急诊科(ED)儿童患者的常见症状。如果之前已经做出了慢性腹痛、周期性呕吐或腹部偏头痛等诊断,就会导致主治医生产生诊断动力和确诊偏差。迪特尔氏危象是儿科常见的漏诊病症,表现为间歇性发作的疼痛和呕吐。通过使用床旁超声检查(POCUS),急诊医生(EP)可以很容易地在床旁对其进行诊断。病例系列我们介绍了两例发作性腹痛和呕吐的儿科患者,他们之前被诊断为周期性呕吐综合征。这两例患者均接受过儿科胃肠病学评估,但诊断性检查结果均为阴性。这两名患者都曾多次就诊于儿科主治医生和急诊室,每次就诊都能治愈症状并出院。每位患者最终都在急诊室就诊时,急诊科医生都在场,并进行了肾脏 POCUS 检查。每位患者的 POCUS 都显示出严重的单侧肾积水。为什么急诊医生应注意这一点?对于儿科患者,在排除输尿管梗阻之前,急诊医生应警惕周期性呕吐综合征的诊断。床旁 POCUS 可以迅速确定这一诊断,并有可能避免反复就医、不必要的诊断检查和永久性肾功能丧失。
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来源期刊
Journal of Emergency Medicine
Journal of Emergency Medicine 医学-急救医学
CiteScore
2.40
自引率
6.70%
发文量
339
审稿时长
2-4 weeks
期刊介绍: The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine
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