Routine Lower Extremity Screening Ultrasound Protocols in Trauma Patients Are Not Cost Effective.

Background: Despite prophylaxis, deep vein thrombosis (DVT) and pulmonary embolism remain dreaded complications following traumatic injury and are associated with significant morbidity and mortality. Screening ultrasound (US) protocols have been employed in trauma centers for early detection of lower extremity (LE) deep venous thrombosis. We hypothesized that screening lower extremity venous duplex US would not prove cost effective in our trauma population who receives early pharmacologic prophylaxis.

Gangrenous Cholecystitis From Gallbladder Volvulus With a Hiatal Hernia.

Gallbladder volvulus is a rare condition involving the rotation of the gallbladder about the cystic duct and vascular pedicle, compromising biliary drainage and blood flow. This report describes a case of gallbladder volvulus presenting in an 88-year-old female with acute onset of right upper quadrant abdominal pain, nausea, and vomiting. Complete work-up included a physical exam, laboratory studies, and computed tomography (CT), which was notable for a markedly distended gallbladder with circumferential wall thickening, pericholecystic fluid, a 12 mm common bile duct, and a hiatal hernia.