Effervescence sign – a new sonographic sign of gastric outlet obstruction: A case report and literature review of superior mesenteric artery syndrome
Bibliographic record
Abstract
Introduction: Superior mesenteric artery syndrome is a rare pathological cause of gastric outlet obstruction. Traditionally, computer tomography and magnetic resonance imaging scans have been diagnostic investigations of choice. However, due to vague symptoms of gastric outlet obstruction, there is a delay to diagnosis of superior mesenteric artery syndrome in acute setting. This case describes the use of point-of-care ultrasound scan for diagnosis of superior mesenteric artery syndrome in the emergency department. Case presentation: We present a case of a 25-year-old woman presenting to the emergency department with signs and symptoms of gastric outlet obstruction caused by superior mesenteric artery syndrome. Point-of-care ultrasound scan demonstrated a fluid-filled stomach with continuous bubbling of air (effervescence sign) and a loop of duodenum compressed between the aorta and the superior mesenteric artery, suggesting a diagnosis of superior mesenteric artery syndrome. Subsequent computed tomography scan confirmed the point-of-care ultrasound scan findings. Discussion: Ultrasound has been described as a reliable diagnostic modality to diagnose the radiological signs of superior mesenteric artery syndrome. Our newly identified sign of continuous bubbling of air (effervescence sign) on point-of-care ultrasound scan, due to fermentation of stomach contents, and its ability to identify diagnostic features of superior mesenteric artery syndrome demonstrate its utility as a diagnostic tool in the emergency department reducing time delays and costs associated with traditional diagnostic modalities. Point-of-care ultrasound scan can aid in the diagnosis of superior mesenteric artery syndrome in the emergency department. Conclusion: Increased awareness of the capabilities of using point-of-care ultrasound scan in the emergency department and our newly identified 'effervescence sign' will enable timely and low-cost diagnoses, while closing current literature gap and establishing point-of-care ultrasound scan as a feasible diagnostic tool for gastric outlet obstruction secondary to superior mesenteric artery syndrome.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.007 | 0.004 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".