Subtle vaginal evisceration resulting in small bowel evisceration: a case report.

Background: Evisceration of bowel contents through the vagina is a rare event that may be complicated by bowel obstruction.

Objective: We report a case of vaginal evisceration with small bowel obstruction which, in contrast to previous, more dramatic case reports in the literature, is a more subtle and, in fact, characteristic clinical presentation for this unusual occurrence.

Case Report: A 72-year-old woman with a previous history of pelvic surgery presented to the Emergency Department with lower abdominal discomfort and a prolapsing mass from her vagina.

Ultrasonography-guided peripheral intravenous catheter survival in ED patients with difficult access.

Objectives: We determined the survival and complications of ultrasonography-guided peripheral intravenous (IV) catheters in emergency department (ED) patients with difficult peripheral access.

Methods: This was a prospective, observational study conducted in an academic hospital from April to July of 2007. We included consecutive adult ED patients with difficult access who had ultrasonography-guided peripheral IVs placed.

Ruptured abdominal aortic aneurysm presenting as painless testicular ecchymosis: the scrotal sign of Bryant revisited.

The diagnosis of ruptured abdominal aortic aneurysm (AAA) is often missed as a result of an atypical presentation, resulting in increased mortality. Here we present an unusual case of painless scrotal ecchymosis as a presentation of ruptured AAA. We review the origin of the scrotal sign of Bryant and emphasize the importance of this uncommon finding as a diagnostic aid in atypical cases of ruptured AAA.

The painful eye.

Emergency physicians are required to diagnose and treat patients who have a painful eye on a regular basis. This article focuses on ophthalmologic emergencies that range in presentation from mild to severe symptomatology and include vision and eye-threatening ailments. The etiology, pathophysiology, physical examination, and treatment of the following conditions are discussed: acute angle closure glaucoma, scleritis, anterior uveitis, optic neuritis, keratitis, and corneal abrasion.

Deadly viral syndrome mimics.

Upper respiratory tract infections (ie, "the common cold") have several hundred causes, the most common of which include rhino-virus, coronavirus, and respiratory syncytial virus. The clinical presentation varies with symptoms. Every emergency department, no matter what the demographics, cares for patients with this constellation of symptoms.