Red. Introduction patients are commonly admitted to hospital under the care of the surgical team with upper abdominal pain. â  this case report highlights the importance of taking a detailed past medical history in order to make an early accurate diagnosis, as what may initially appear to be a common presenting complaint may arise from an uncommon and potentially very serious pathology. Case presentation a 51 year old previously fit and well man presented to the emergency department with sudden onset of severe epigastric pain and vomiting. â  the pain was described as sharp and constant, of 3 hours duration, and radiated to his right shoulder. â  it was unremitting, and he had not experienced it previously, although there was a vague history of a minor road traffic accident approximately 12 years earlier. On examination he was alert and orientated, although clearly in significant pain. â  he was tachypnoeic (23rpm) and tachycardic (96bpm). â  cardiovascular and respiratory examinations were otherwise unremarkable. His abdomen was soft and not distended but was tender in the right upper quadrant and epigastrium. Investigations demonstrated a mildly elevated white blood cell count, with the rest of the blood tests normal. â  an erect chest x-ray showed an area of increased opacification in the right lower zone, with gas in the right subphrenic space which was reported to be chilaiditi’s syndrome. (figure 1) figure 1: chest radiograph taken shortly after admssion an unusual gas pattern was noted in the right lower zone, raising the suspicion of a small bowel diaphragmatic hernia, perhaps through the foramen of morgagni. â  following initial resuscitation the patient underwent a ct scan. â  this confirmed a hernia through the mid part of the right hemi-diaphragm, containing omentum and loops of small bowel. â  (figure 2) figure 2: ct scan of chest & abdomen demonstrating diaphragmatic hernia the patient was taken to theatre, and a 3 port laparoscopy was performed. cheap viagra online buy cheap viagra buy viagra cheap viagra online buy cheap viagra cheap generic viagra cheap generic viagra buy cheap viagra Initial findings were of dilated small bowel overlying.

Expertise in maximising ROI potential from your BMC Business Service Management Solutions // MORE ON BMC

Consulting Services & Bespoke Solutions
We specialise in providing a specialised & "personal" approach to Consulting Services for BMC Business Service Management (BSM) solutions.

Also providiong System Integrator Services & tailored solutions based on bespoke requirements.

BMC Partner & Expert Resources

As a BMC Consulting Partner & Supplier, our consultants are certified, BMC Remedy accredited, and adhere to software development & project methodologies, in line with that of BMC Consulting Services.

safe sites to buy viagraConsulting Services
Our consultants work with BMC Software's Consulting Services, fulfilling resources & consulting needs for delivery of BSM, ITIL & ITSM solutions to leading Global businesses. Consultants are certified in BMC & Remedy solutions.

Bespoke Solutions
We work closesly with our customers to ensure we provide tailored solutions to fit requirements and needs of a each customer & their buisness area. Whether this is System Inetgration to Full Systems



Hot off the Press

See the links below for the latest Podcasts, RSS feeds and news regarding ITSM and BSM Solutions from BMC

Copyright © Zimal Consulting (Zimal.Com)