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Case 132

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58-year-old male was admitted at the emergency department without evacuating for 3 days, but with persistent elimination of flatus. He was complaining about nausea, vomiting, abdominal cramps and loss of appetite. At the physical examination there was hyperperistaltic bowel sounds, abdominal distension and diffuse pain on deep abdominal palpation. The patient was previously healthy, without any comorbidities. He denied previous surgical procedures into the abdominal cavity. The results of the laboratory tests showed an increase of the amylase and C-reactive protein.

Based on the clinical presentation, laboratory and imaging studies, we can affirm that the alternatives below are correct, except:

a) The increase of amylase suggests pancreatitis

25%

b) The obstruction of the small bowel is partial

25%

c) The surgical management is indicated

25%

d) The superior mesenteric artery is pervious

25%
   

Comments

- The main causes of bowel obstruction are the adhesions, tumors and hernias.

- The most commons symptoms are intermittent hyperperistaltic bowel with cramping abdominal pain, nausea, vomiting, dehydration and shock.

- The imaging studies that may help with the diagnosis are: simple radiographs of the abdomen in orthostatic and dorsal decubitus positions and also chest x-ray; CT scan of the abdomen and pelvis.

- Electrolyte panel, complete blood count, lactate and arterial blood gas analysis are important to establish the severity of the situation.

- Managements: hospitalization, fasting, monitoring, correction of electrolytic disorders, intestinal decompression and oxygen therapy. Antimicrobials and surgery may be considered.

References

- Bordeianou L, Yeh DD. Epidemiology, clinical features, and diagnosis of mechanical small bowel obstruction in adults. Soybel DI, Hockberger RS, editors. Waltham (MA): UpToDate; 2013. Available at: http://www.uptodate.com/contents/epidemiology-clinical-features-and-diagnosis-of-mechanical-small-bowel-obstruction-in-adults

- Sabiston DC, Townsend CM. Sabiston tratado de cirurgia: as bases biológicas da prática cirúrgica moderna. 17ª  ed. Rio de Janeiro: Elsevier; 2005.

Author

Fabiana Resende, 6th year medical student of UFMG School of Medicine

E-mail: fabianaresende1[at]gmail.com

Supervisors

Prof Fabiana Paiva, radiologist, professor of the Department of Anatomy and Imaging at UFMG School of Medicine
E-mail: fabpaivamartins[at]medicina.ufmg.br
Prof Tarcizo Afonso Nunes, surgeon, professor of the Department of Surgery at UFMG School of Medicine
E-mail: tan[at]medicina.ufmg.br

Reviewers

Hercules Riani, Thaís Araújo, Prof Viviane Parisotto

Translated by

Hercules Hermes Riani Martins Silva, 4th year medical student at UFMG School of Medicine
E-mail: herculesriani[at]gmail.com

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