Question

A 45-year-old woman presents to the emergency room for abdominal pain, nausea, and nonbloody vomiting for the past day. She has not had any flatus during this time. She also endorses decreased appetite. She has a past surgical history of cesarean section. On physical exam, there is diffuse tenderness to palpation of her abdomen but no rebound tenderness or guarding. An abdominal radiograph shows dilated loops of small bowel, which is confirmed with a CT abdomen and pelvis. There are no masses identified. She is admitted to the inpatient floor and a nasogastric tube is placed. What is the diagnosis?

Answer 1

A 45-year-old woman presenting with abdominal symptoms and a history of cesarean section likely has a bowel obstruction, possibly due to postoperative adhesions, as indicated by the imaging findings and absence of other specific symptoms.

Step-by-step explanation:

The 45-year-old woman who presents to the emergency room with abdominal pain, nausea, and nonbloody vomiting, in addition to no flatus and decreased appetite, suggests a diagnosis of a bowel obstruction.

This condition is supported by the physical exam findings of diffuse tenderness without rebound tenderness or guarding and imaging results indicating dilated loops of small bowel with no masses identified. Considering her past surgical history of cesarean section, it is plausible that the bowel obstruction could be due to adhesions, which is a common postoperative complication.

The absence of flatus and the radiographic findings of dilated loops of bowel, along with the absence of masses on the CT scan and the absence of other symptoms that might suggest an alternative diagnosis, such as appendicitis, UTI, or PID, are all consistent with this diagnosis. The placement of a nasogastric tube is a standard intervention to relieve gastric distention and reduce vomiting in the case of bowel obstruction.