Spotlight Case March 2005. The Hidden Mystery. Source and Credits. This presentation is based on the March 2005 AHRQ WebM&M Spotlight Case in Hospital Medicine See the full article at http://webmm.ahrq.gov CME credit is available through the Web site
Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.
The Hidden Mystery
At the conclusion of this educational activity, participants should be able to:
A 45-year-old morbidly obese woman with diabetes mellitus was transferred to a tertiary care center for management of abdominal pain, vomiting, and subjective fevers. Upon transfer, the patient complained of diffuse abdominal pain. She was febrile with stable vital signs. Exam revealed a diffusely tender abdomen with chronic erythematous changes extending over her pannus.
Empiric broad-spectrum antibiotics were started. The consulting surgeon recommended abdominal imaging, but the patient was unable to fit in the CT scanner or MRI due to her obesity. She was observed, and her abdominal pain was treated with narcotics.
Source: CDC web site. Flegal KM, et al. Int J Obes Relat Metab Disord. 1998;22:39-47. NIH. Obes Res. 1998;6 Suppl 2:51S-209S
Obesity* Trends Among U.S. Adults
Source: Behavioral Risk Factor Surveillance System, CDC.
Source: Mokdad AH, et al. JAMA. 2004;291:1238-45.
Source: Varon J, Marik P. Crit Care Clin. 2001;17:187-200; Boulanger BR, et al. J Trauma.1988;45:52-56; Melanson SW, Heller M. Emerg Med Clin North Am. 1998;16:165-89; McKenney KL. Radiologic Clin North Am. 1999;37:879-93.
Source: Hahler B. Medsurg Nurs. 2002;11:85-90; Davidson JE, et al. Crit Care Nurs Q. 2003;26:105-18.
Williamson JA, et al. Anaesth Intensive Care. 1993;21:602-7;
Rocke DA, et al. Anesthesiology. 1992;77:67-73.
Boulanger BR, et al. Crit Care Clin. 1994;10:613-95.
Brunette DD. Am J Emerg Med. 2004;22:40-7.
Six days later, the patient developed fevers, hypotension, and leukocytosis. Exam showed newly identified gangrenous pannus in the deep skin folds. She was taken to the OR for presumed necrotizing fasciitis. Surgical exploration revealed a colocutaneous fistula arising from perforated sigmoid diverticula. The patient died of multiorgan failure after a complex several-month hospital course.
Source: Schwilk B. Anasthesiol Intensivmed Norfallmed Schmerzther. 1995;30:99-107; Heinzelmann M. Am J Surg. 2002;183:179-90.
Cruse PJ, Foord R. Surg Clin North Am. 1980;60:27-40;
Schwilk B. Anasthesiol Intensivmed Norfallmed Schmerzther. 1995;30:99-107
Source: Nanasiak M, Murr MM. Obes Surg. 2001;11:677-9;Wiese HJ, et al. Int J Obes Relat Metab Disord. 1992;16:859-68.