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.
Goddard SA, Lundberg PW, Jones SD. Small-Bowel Obstruction in a 45-Year-Old Woman. JAMA Surg. Published online April 26, 2017. doi:10.1001/jamasurg.2017.0545