The EM Educator Series: When the bowel flips on you

Author: Alex Koyfman, MD (@EMHighAK) // Edited by: Brit Long, MD (@long_brit) and Manpreet Singh, MD (@MprizzleER)

Welcome to this week’s EM Educator Series. These posts provide brief mini-cases followed by key questions to consider while working. The featured questions provide important learning points for those working with you, as well as vital items to consider in the evaluation and management of the specific condition discussed.

This week has another downloadable PDF document with questions, links and answers you can share with learners as educators in #MedEd. Please message us over Twitter and let us know if you have any feedback on ways to improve this for you. Enjoy!


Case #1:

A 75-year-old female from a nursing home presents with severe abdominal pain and distension, with no bowel movements for over one week. She appears ill.



  • What do you need to consider with abdominal pain in the elderly?
  • What about the chief complaint of constipation in the elderly patient? What other conditions do you need to consider?
  • What are risk factors & clinical presentations regarding cecal and sigmoid volvulus?
  • What’s the ED work-up and classic X-ray findings in cecal and sigmoid volvulus? Are there limitations in x-ray?
  • What’s the ED management of cecal and sigmoid volvulus? What complications do you need to consider?
  • How do you identify sepsis from an abdominal source in the elderly patient? How do you manage sepsis in this population?
  • What do you need to consider regarding code status and goals of care?


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