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JAMA Surgery Clinical Challenge
June 2017

Acute Large-Bowel Obstruction in an Institutionalized Man

Author Affiliations
  • 1Emergency Surgery Unit, Maggiore Hospital Regional Emergency Surgery and Trauma Center, Bologna Local Health District, Bologna, Italy
  • 2Gastroenterology and Endoscopy Unit, Maggiore Hospital Regional Emergency Surgery and Trauma Center, Bologna Local Health District, Bologna, Italy
JAMA Surg. 2017;152(6):597-598. doi:10.1001/jamasurg.2017.0507

A 77-year-old institutionalized and bedridden man with severe Alzheimer dementia and long-standing schizophrenia was admitted to the emergency department for bowel obstruction with progressive abdominal distension and tenderness. His family members and caregivers accompanied him. At physical examination the patient was pale, sweaty, peripherally hypoperfused, tachypnoeic, and dehydrated, and the abdomen was extremely distended, diffusely tympanic, and tender at palpation. His blood pressure was 90/70 mm Hg, his heart rate was 114 beats per minute, his oxygen saturation was at 90%, his arterial blood gas pH level was 7.43, his partial pressure of carbon dioxide was 32, his partial pressure of oxygen 68, his laceration lactate level was 5.0, and his white blood cell count was 24 000 mm3. A plain abdominal radiograph showed a huge colonic distension (Figure 1A). A computed tomography scan with multiplanar reconstruction was also performed (Figure 1B).

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