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JAMA Surgery Clinical Challenge
June 2014

Rare Cause of Recurrent Small-Bowel Obstruction

Author Affiliations
  • 1Department of Surgery, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
JAMA Surg. 2014;149(6):617-618. doi:10.1001/jamasurg.2013.2531

A 34-year-old female Jehovah’s Witness presented to the emergency department with a 3-day history of colicky lower abdominal pain, nausea without vomiting, and constipation after passing a single small bloody bowel movement. Physical examination demonstrated a soft, nontender, and nondistended abdomen without peritoneal signs or palpable masses. Digital rectal examination revealed no stool in the vault and gross blood and pelvic examination were negative.

Surgical history was notable only for a previous cesarean delivery. Medical history was significant for 2 years of waxing and waning generalized abdominal pain and a hospital admission for small-bowel obstruction 11 months prior that was managed conservatively. Endoscopic evaluation revealed multiple polyps in the colon, stomach, and duodenum consistent with a diagnosis of juvenile polyposis syndrome.