This is the podcast, ICU rounds.

My name is Dr. Jeffrey Guy.

I'm an associate professor of surgery and director at the Burns Center at the Vanderbilt University of School of Medicine in Nashville, Tennessee.

Welcome back to the podcast.

I want to start the discussion by presenting a patient to you.

The patient is a 65-year-old gentleman who gets admitted to, in this case, the burn in type of care unit because the patient sustained deep third-degree burns on about 20% of his body involving his lower extremities.

But he has a history remarkable for some atherosclerotic coronary disease.

He has atrial fibrillation chronically, goes in and out of sinus rhythm. The cardiologists only hope

that they can keep the ventricular rate controlled and that's with use of amyodorum. And the patient

has a history of hepatitis C, but no real alterations in the patient's liver function

tests. The patient goes to the operating room for excision of the bird's placement in

allograph, trying to stage the operative procedure due to the patient's comorbidities. And in the

post-operative period, the patient begins to complain of some abdominal distension, not really any kind of pain he is, passing flitis, having some liquid

bowel movements, and a little bit of a respiratory embarrassment because of the gastric distension.

You examine the abdomen. He's got obviously a distended abdomen. It's some panic, and there's no guarding a rebound tenderness to palpation.

Rectal exam is normal.

You get a flat plate of the abdomen, and on the flat plate of the abdomen, you notice some

rather significant distension air-filled colon, away from the right colon all the way to the

seacum, and a cecum measured about 14

sonometers in diameter.

He obviously checks him electrolytes, but your diagnosis of this is what's commonly referred to

as Oglevees, which may or may not be the appropriate name, but perhaps the more politically

...