In anticipation of episode number 42 on belly pain in the adult, we have with us Dr. Brian

Steinhart, who's been on EM cases several times before.

He's going to tell us his best case ever when it comes to adult abdominal pain.

Dr. Steinhart, let it rip.

Thanks, Anton. So I'm going to take a speaker's prerogative and in the next five minutes tell you

five of my best cases that I guess are titled, Thinking Outside the Box.

And so my first case was a memorable case, was an elderly individual who presented psychotic

from home where he was known to be self-sufficient with no psychiatric illness and was just

came in agitated, vomiting, clutching his belly. And I could not figure out what was going on at the bedside

and ordered all sorts of tests. And it's only when his wife showed up and said, well,

doctor, what do you think of my husband's red eye? And I looked and lo and behold, he had an injected left eye. And I took

the patient's pressure. He was able to calm down to use a Shiott's tonometer in those days.

And lo and behold, his intraocular pressure was sky high in the affected eye versus the other eye.

And so I called my ophthalmology colleague an initiated treatment

who staff then saw the patient and said,

no, no, he's got an acute abdomen, call the surgeon.

I'll deal with the eye postoperatively.

And I was quite convinced this patient had acute angle

closure, glaucoma as a cause of all his symptoms and proceeded to lower his pressure. And lo and

behold, 20 minutes later, his abdominal pain disappeared, his psychosis disappeared, as his intraocular pressure disappeared.

I called back the ophthalmologist who then conceded that, yes, okay, he has acute angloce glaucoma,

but still required general surgery to clear his benign abdomen before he accepted him onto his ward.

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