JACEP
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A patient with hiccups was found to have an abdominal aortic aneurysm that subsequently ruptured. We believe that a leaking abdominal aortic aneurysm led to an ileus-induced distention of the splenic flexure of the colon with consequent diaphragmatic irritation and phrenic nerve stimulation. This led to persistent hiccups as a result of repetitive stimulation of the reflex arc mediating hiccups. Persistent hiccups require investigation for an underlying organic etiology, and a leaking abdominal aortic aneurysm should be included in the differential diagnosis.
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A retrospective study of 117 cases of pelvic fracture was undertaken to determine the incidence of associated abdominopelvic injury. Fractures of the pubic rami were found to be most common. Seventeen patients (15%) had significant intra-abdominal or genitourinay injury. ⋯ Seventy-three of 84 (87%) patients who had urinalyses in the emergency department had microscopic or gross hematuria. Of these, only those with gross hematuria had significant urologic injury. There were four fatalities.
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Benign intracranial hypertension, an unusual case of headaches, was associated with pregnancy in a gravid female with the chief complaint of headache. Symptoms resolved after three days of prednisone therapy. ⋯ The only symptom may be headache and the only physical sign, papilledema. Therefore, neurological examination must include visualization of the fundi.