Surgery pp 15-21 | Cite as

Abdominal Pain, Nausea, and Vomiting


A 38-year-old woman presents to the emergency department with colicky abdominal pain, nausea, and vomiting for the past day. She has had at least 10 episodes of green, bilious emesis without blood. She has had no passage of stool or flatus per rectum since yesterday morning and has not eaten in 24 hours due to the vomiting and abdominal pain. She denies a history of similar symptoms and has no other medical problems. Past surgical history is significant for a C-section 2 years ago. On physical examination, her temperature is 99.3 °F, heart rate is 122/min, blood pressure is 124/78 mmHg, and respiratory rate is 14/min. Her mucous membranes are dry and her abdomen is distended, with a well-healed low transverse abdominal incision. Auscultation reveals high-pitched tinkling bowel sounds. She has mild tenderness throughout the abdomen, but there is no rebound, guarding, or rigidity. No masses or hernias are identified. Rectal examination reveals normal tone, no gross blood, no masses, and no stool in the rectal vault. Laboratory examination is significant for a white blood cell count of 8.2 × 103/μL (normal 4.1–10.9 × 103/μL), hemoglobin 17 g/dL (12.3–15.7 g/dL), hematocrit 51 % (37–46 %), sodium 141 mEq/L (135–145 mEq/L), potassium 2.9 mEq/L (3.5–5.0 mEq/L), chloride 93 mmol/L (98–106 mEq/L), bicarbonate 31 mEq/L (24–30 mEq/L), BUN 30 mg/dL (7–22 mg/dL), and creatinine 1.2 mg/dL (0.56–1.0 mg/dL). Abdominal x-ray is provided in Fig. 2.1.


Small bowel obstruction Large bowel obstruction Flatus Constipation Obstipation Loops of bowel Air-fluid levels Ogilvie Closed loop obstruction Hernia 

Suggested Reading

  1. Cheadle WG, Garr EE, Richardson JD. The importance of early diagnosis of small bowel obstruction. Am Surg. 1988;54:565.PubMedGoogle Scholar
  2. Kozol R. Mechanical bowel obstruction: a tale of 2 eras. Arch Surg. 2012;147:180.CrossRefPubMedGoogle Scholar
  3. Markogiannakis H, Messaris E, Dardamanis D, et al. Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome. World J Gastroenterol. 2007;13:432.CrossRefPubMedCentralPubMedGoogle Scholar
  4. Miller G, Boman J, Shrier I, Gordon PH. Natural history of patients with adhesive small bowel obstruction. Br J Surg. 2000;87:1240.CrossRefPubMedGoogle Scholar
  5. Taylor MR, Lalani N. Adult small bowel obstruction. Acad Emerg Med. 2013;20:528.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of SurgeryDavid Geffen School of Medicine at UCLALos AngelesUSA
  2. 2.Department of SurgeryUniversity of California at Los AngelesSanta MonicaUSA

Personalised recommendations