Background: Large volume preparations that are polyethylene glycol based (such as GoLYTELY and MiraLAX) are the mainstay of bowel preparation regimens at many institutions. Studies have shown that patients prefer lower volume preparations compared to the standard 4 Liters of polyethylene glycol electrolyte solutions (PEG- ELS). Although data has been collected on low volume bowel [...]

Background: With the dramatic increase in the usage of opioids for not only inpatient but also outpatient pain management, a potential increase in opioid-related deaths had led to a national concern regarding opioid usage. The World Health Organization analgesic ladder estimates 90% of the global population will use opioids at least once in their life, [...]

Case Presentation: A 61 year old female presented to the emergency department with 1 day of nausea, vomiting, and fever. The day prior to her symptom onset, she had undergone a colonoscopy for colon cancer screening that was normal. Her medical history was notable for splenectomy in 2000 for a hamartoma.On presentation, her temperature was [...]

Background: Clostridium difficile infections (CDI) is a notorious nosocomial threat to health and a leading cause of infectious diarrhea. It is associated with billions of dollars of US health care costs annually due to long hospital stays and readmissions. While CDI is mostly caused by toxin-producing strains, some strains do not express these proteins. These [...]

Case Presentation: An 89 year-old woman was admitted for several days of severe constipation, abdominal bloating and absence of flatus. She had abdominal distention with minimal abdominal tenderness on exam. Initial CT imaging demonstrated significant stool burden with prominent colonic distension extending from the cecum to the transverse colon. She required nasogastric tube decompression. Several [...]

Case Presentation: A previously healthy 54-year-old African American woman with a history of chronic constipation and tobacco use disorder presented to the emergency department with a 3-day history of intermittent left lower quadrant (LLQ) cramping abdominal pain which radiated to her back and an associated 5-day history of fatigue. She had no prior colonoscopy. On [...]

Case Presentation: A 94-year-old man with no significant past medical history presented to the Emergency Department with a two week history of progressively worsening constipation accompanied by nausea, vomiting, and abdominal pain. He denied any hematochezia, melena, change in stool caliber or unintentional weight loss. He had never undergone a colonoscopy. He had tried stool [...]

Background: Some patients lack the functional capability or social support to perform their own colonoscopy bowel preparation. These patients may be admitted to Inpatient units for support with the bowel preparation, but this process can be costly, lead to long lengths of stay, and decrease the admitting capacity of the hospital. An observation unit may [...]

Case Presentation: A 59 year-old male with intellectual disability presented with abdominal pain and distension following a fecal impaction. Imaging revealed diffuse gaseous colonic distension with colonic wall thickening suggestive of inflammatory colitis and colonic ileus without obstruction. His labs were notable for severe hypokalemia (1.5 mmol/L) and mild hypomagnesemia. Despite empiric antibiotic course, imaging [...]

Case Presentation: A 59-year-old incarcerated male presented to the hospital with abdominal pain, fever, and vomiting. Initial diagnostic workup showed a total leukocyte count of 14.2 x 103 /uL. The alkaline phosphate and total bilirubin were normal at 73 IU/L and 1.2 mg/dL, respectively. The Computerized tomography (CT) with contrast of the abdomen and pelvis [...]