Category 3, Item 19
A 45-year-old man with the arthrogryposis recovering in a rehabilitation facility after hip replacement requires chronic narcotic analgesics for pain management. Over the past four days he has had progressive abdominal distention and obstipation. On examination he is afebrile with normal vital signs. His abdomen is tensely distended, tympanic, and tender without rebound. High-pitched bowel sounds are heard with rushes. An old lower midline incision is well healed and without evidence of hernia. Inguinal hernias are not identified by physical examination and the rectal examination is normal. The flat and upright abdominal x-rays shown are obtained.
Primary management options may include all of the following EXCEPT
(A) epidural anesthesia
(B) intravenous neostigmine
(C) colonoscopy
(D) nasogastric decompression
(E) immediate operative decompression
For the incomplete statement above, select the lettered completion that is best of the 5 given.
For the answer and a critique of item 19 see page 262.
(Reproduced by permission from SESAP No. 11 2002–2004 Syllabus, volume 1. For enrolment in the Surgical Education and Self-Assessment Program, please apply to the American College of Surgeons, 633 North St. Clair St., Chicago IL 60611-3211, USA; tel 312 202-5000; fax 312 202-5001; postmaster@facs.org)
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