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Norovirus Gastroenteritis Leading to Partial Small Bowel Obstruction David Berry DO, Arthur Cecchini DO, Koushik Sanku MD, Bhavesh Gajjar MD Berrydw@etsu.edu, Cecchini@etsu.edu, Sankuk@etsu.edu, Gajjarb@etsu.edu Department of Internal Medicine, Quillen College of Medicine, East Tennessee State University BACKGROUND Acute gastroenteritis (AGE) is a common problem in both inpatient and outpatient settings. Most cases are viral in origin, with norovirus being the most cited. Typical symptoms include low-grade fever, chills, nausea, vomiting, and abdominal discomfort. The physical examination is usually unremarkable, but abdominal tenderness or signs of volume depletion may be present in severe disease. Most patients have spontaneous remission within a few days and do not require hospitalization or diagnostic evaluation. Laboratory evaluation is often helpful in severe disease, immunocompromised patients, or when bloody or mucoid diarrhea is present. Polymerase chain reaction (PCR) gastrointestinal multiplex testing is often the preferred evaluation as it has a high sensitivity, specificity, and turnaround time when compared to traditional stool studies of enzyme-immunoassay studies. Treatment is often supportive, but specific bacterial and parasitic pathogens should prompt treatment with antimicrobial therapy. CASE PRESENTATION This case presents a 47-year-old male with no known previous medical history or history of intraabdominal surgeries. He presented with four days of progressive nausea, vomiting, diarrhea, and abdominal discomfort. The physical examination revealed a distended and tender abdomen. The metabolic panel did not show any electrolyte derangements. Computed tomography with intravenous contrast revealed partial small bowel obstruction versus less likely ileus. Gastrointestinal pathogen PCR returned positive for norovirus. The patient was given intravenous fluid, nausea control, and pain control, his diet was advanced, and his symptoms subsequently resolved. We believe this case to be unusual, as most cases of viral gastroenteritis are uncomplicated, and this patient presented with radiographic evidence of ileus versus partial small bowel obstruction. PCR testing revealed positivity for norovirus. He had no previous abdominal surgeries or family history of early intestinal malignancies, and the symptoms spontaneously resolved with several days of conservative management, making another etiology much less likely. CONCLUSION AGE is a common diagnosis seen in the primary care clinic, and most patients have an uneventful recovery. However, suspicion of partial obstruction or intestinal ileus should arise when severe abdominal pain and prolonged vomiting are present. |
