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JAMA Surgery Clinical Challenge
June 2017

Small-Bowel Obstruction in a 45-Year-Old Woman

Author Affiliations
  • 1Department of General Surgery, Tulane University School of Medicine, New Orleans, Louisiana
JAMA Surg. 2017;152(6):599-600. doi:10.1001/jamasurg.2017.0545

A 45-year-old woman presented to the emergency department on the morning after Thanksgiving with sudden, severe, constant epigastric pain that migrated to the right upper quadrant as well as subjective fever and emesis since the previous evening. She reported a failure to pass stool or flatus since the onset of symptoms. She denied hematochezia, melena, or hematemesis. Her medical history was significant for heavy smoking, reflux, and surgical procedures including a right inguinal hernia repair, total abdominal hysterectomy, and bilateral salpingo-oopherectomy, all more than 5 years prior. On examination, she had a distended and tympanic abdomen with tenderness, guarding, and rebound in the epigastrium and right upper quadrant. Vital signs and standard laboratory test results were unremarkable.

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