Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a history of Crohn's disease, reporting progressive postprandial abdominal pain, bloating, and nausea. Symptoms are consistent with subacute small bowel obstruction. Reports weight loss, decreased stool caliber, and episodic emesis. No evidence of systemic sepsis or peritonitis at this time.
Clinical Examination Findings
Abdomen is distended with visible peristalsis. Hyperactive bowel sounds noted. Tenderness to palpation in the [RLQ/mid-abdomen], without rebound or guarding. Digital rectal exam reveals no masses. No signs of hernia. Stable vital signs.
Treatment Protocol
Plan: NPO status, nasogastric tube decompression, and IV fluid resuscitation. Initiate bowel rest. Surgical consultation for potential strictureplasty or segmental bowel resection. Monitor for signs of bowel perforation or complete obstruction.