Nissen fundoplication

So we'll do this a little oral board style for you here, Matt.

So we've got a 42-year-old male who's got a history of a Nissen fundoplication and for a hiatal hernia a couple months ago, who presented to the ED with abdominal pain and distension.

Okay, I walk into the room.

What do I see? Can we get a set of vitals and talk to the patient, or did EMS provide us a little bit more history?

Now, if those techniques do not work, of course, definitive management is a laparotomy, preferably done in the operating room.

So one final note that the authors mention here are various techniques to place an NG tube when you are having trouble.

Now, in this case report, the patient's prior Nissen fundoplication, which can lead to impairment in getting the lower esophagus to relax properly, this likely contributed to the failure to place the NG tube into the stomach.

However, if you are having trouble placing the NG tube, there are several methods that have been studied.