What is the diagnosis for a patient presenting with vomiting, who underwent a computed tomography (CT) scan of the abdomen and pelvis without intravenous (IV) contrast, showing prominent fluid-filled small bowel loops and wall thickening of the stomach, with a stable right renal hypodensity, and a history of cholecystectomy (surgical removal of the gallbladder)?

From the Guidelines

The patient's CT scan findings suggest mild gastroenteritis or ileus, rather than a bowel obstruction, and treatment should focus on managing symptoms with clear liquids, advancing to a bland diet as tolerated, and anti-nausea medication such as ondansetron 4mg every 6 hours as needed. The CT scan shows a few prominent small bowel loops in the left abdomen and stomach wall thickening, which is consistent with mild gastroenteritis or ileus 1. According to the American College of Radiology, abdominal radiography has been the traditional starting point for the imaging evaluation of suspected small-bowel obstruction, but CT provides much more information, including the site and cause of the obstruction and complications of SBO 1.

The scan also revealed a 10mm low-density area in the right kidney, classified as a possible Bosniak 2F cyst, which requires a follow-up ultrasound in 3 months to ensure stability 1. This type of cyst has some concerning features but is likely benign. The patient has had their gallbladder removed previously (cholecystectomy). For the gastroenteritis symptoms, ensure adequate hydration, rest, and seek medical attention if symptoms worsen, particularly if vomiting persists, abdominal pain increases, or fever develops. The kidney finding is likely incidental but requires the recommended follow-up to rule out any concerning changes over time.

Key points to consider in management include:

• Managing symptoms with clear liquids and advancing to a bland diet as tolerated
• Using anti-nausea medication such as ondansetron 4mg every 6 hours as needed
• Ensuring adequate hydration and rest
• Seeking medical attention if symptoms worsen
• Following up on the kidney finding with an ultrasound in 3 months to rule out any concerning changes over time.

From the Research

CT Abdomen and Pelvis Findings

• The CT scan of the abdomen and pelvis without IV contrast shows no confluent infiltrate or substantial soft tissue pulmonary nodule in the visualized lung bases.
• The liver, spleen, adrenal glands, and pancreas are without obvious lesions or abnormalities.
• A low-density right renal cortical focus, similar to a small cyst, is noted.
• The urinary bladder and reproductive organs show no acute pathology.
• The bowel shows prominent fluid-filled small bowel loops in the left upper and left mid abdomen, suggesting enteritis or focal ileus.

Possible Causes of Vomiting

• According to 2, nausea and vomiting can be associated with various underlying causes, including gastrointestinal diseases, metabolic and endocrine conditions, and psychogenic disorders.
• 3 discusses small bowel obstruction, cyclic vomiting, and gastroparesis as potential causes of vomiting, highlighting the importance of early diagnosis and appropriate management.
• 4 notes that acute nausea and vomiting can be treated symptomatically, while chronic symptoms require a more thorough evaluation to determine the underlying cause.
• 5 emphasizes the importance of history and physical examination in determining the likely cause of acute nausea and vomiting, and suggests basic laboratory testing and imaging studies as needed.
• 6 discusses the evaluation and treatment of chronic nausea and vomiting, highlighting the diversity of disorders that can cause these symptoms and the importance of distinguishing between gastrointestinal and non-gastrointestinal causes.

Diagnostic Approach

• The CT scan findings, combined with the patient's symptoms, suggest a possible diagnosis of mild gastroenteritis or ileus, as noted in the impression.
• A three-month follow-up sonogram may be of value to further evaluate the right renal cortical focus.
• The patient's vomiting may be related to the enteritis or focal ileus, and treatment should be directed at managing these symptoms and addressing any underlying causes.