![]() ![]() ![]() SBO from adhesions can present many years after surgery. ![]() This patient has evidence (on history, physical, and radiologic imaging) of a small bowel obstruction (SBO) that is most likely secondary to adhesions from prior surgery (scar in RUQ). Amylase, lipase, and liver chemistries are normal. ![]() Abdominal series demonstrates one loop of markedly distended small bowel in the right upper quadrant with an air fluid level. The rest of the abdominal exam is unremarkable. He has marked right upper quadrant tenderness to palpation with guarding. Bowel sounds are hyperactive with occasional rushes and tinkles. His abdomen has a well-healed midline scar and is distended. On physical exam, his temperature is 100.9 ☏, blood pressure is 110/80 mmHg, and heart rate is 110/min. Past history is significant for prior sigmoid colectomy for diverticulitis 10 years ago. "Rappers I monkey flip em with the funky rhythm I be kicking/Musician, inflicting composition/of pain I'm like Scarface sniffing cocaine/Holding a M-16, see with the pen I'm extreme, now/Bullet holes left in my peepholes/I'm suited up in street clothes/Hand me a nine and I'll defeat foes/Y'all know my steelo with or without the airplay/I keep some E&J, sitting bent up in the stairway/Or either on the corner betting Grants with the celo champs/Laughing at baseheads, tryin' to sell some broken amps/G-Packs get off quick, forever n***** talk s***/Reminiscing about the last time the Task Force flipped/N***** be running through the block shootin'/Time to start the revolution, catch a body, head for Houston/Once they caught us off-guard, the Mac-10 was in the grass and/I ran like a cheetah with thoughts of an assassin/Pick the Mac up, told brothers, "Back up," the Mac spit/Lead was hitting n*****, one ran, I made him back flip/Heard a few chicks scream, my arm shook, couldn't look/Gave another squeeze, heard it click, "yo, my s*** is stuck"/Try to cock it, it wouldn't shoot, now I'm in danger/Finally pulled it back and saw 3 bullets caught up in the chamber/So now I'm jetting to the building lobby/And it was full of children probably couldn't see as high as I be/(So what you saying?) It's like the game ain't the same/Got younger n***** pulling the triggers, bringing fame to their name/And claim some corners, crews without guns are goners/In broad daylight, stickup kids: they run up on us/4-5's and gauges, Macs, in fact/Same n***** will catch a back-to-back, snatching your cracks in black/There was a snitch on the block getting n****s knocked/So hold your stash 'til the coke price drop/I know this crackhead who said she's got to smoke nice rock/And if it's good, she'll bring you customers in measuring pots/But yo, you gotta slide on a vacation, inside information/Keeps large n***** erasin' and their wives basin'/It drops deep as it does in my breath/I never sleep, cause sleep is the cousin of death/Beyond the walls of intelligence, life is defined/I think of crime when I'm in a New York state of mind.A 65-year-old male presents to the ED with nausea, vomiting, and severe abdominal pain. ![]()
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