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March 14, 1980

Intestinal Obstruction in a 55-Year-Old Man With Previous Thoracic Surgery (Extrapleural Plombage)

JAMA. 1980;243(10):1077-1078. doi:10.1001/jama.1980.03300360049030

History  A 55-year-old man came to the Miami Veterans Administration Hospital with a 48-hour history of crampy abdominal pain associated with nausea, vomiting, and diarrhea. The patient denied fever, genitourinary symptoms, or previous abdominal surgery.The patient's medical history was relevant in that he underwent bilateral collapse therapy with Lucite sphere plombage in 1946 for pulmonary tuberculosis. In January 1977, an empyema and bronchopleural fistula of the left hemithorax developed, requiring removal of 37 Lucite spheres and long-term antituberculous therapy. Review of systems indicated chronic, severe, nonproductive cough.Laboratory data at time admission disclosed a WBC count of 20,800/cu mm, with a shift to the left. Amylase, glucose, BUN, and electrolyte levels were within normal limits. Urinalysis revealed seven to ten WBCs per high-power field and an occasional RBC per high-power field. Admission posteroanterior chest films and anteroposterior films of the abdomen were obtained (Fig 1 and 2).

Diagnosis  Extrapleural