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38. Internal Hernias: No Bulge, No Hernia?
Keywords
Internal herniaGastric bypassRoux-en-YCase 1
Abdominal Pain after Roux-En-Y
Pertinent History
A 47-year-old female presented to the emergency department (ED) complaining of abdominal pain, nausea, and vomiting. The pain is located in the epigastric area, and symptoms have been intermittent but have progressively worsened over the past 3 days to the point that she is now unable to tolerate any oral intake, even liquids. She has not had any fevers. She normally has bowel movements every day but thinks that she has not had one in 2 days. She is not passing flatus. She has not had any diarrhea and denies any sick contacts.
Pertinent Physical Exam
Except as noted below, the findings of the complete physical exam are within normal limits.
Vitals: Temperature 98.7, HR 115, BP 143/86, RR 18, O2 saturation 99% on room air
HEENT: Dry mucous membranes
CV: Mild tachycardia
Abdomen: Mild guarding with moderate associated tenderness in the epigastric area. No rebound tenderness
PMH
Morbid obesity, hypertension, hyperlipidemia, type 2 diabetes, GERD. Roux-en-Y gastric bypass performed 8 years ago
SH
Ten pack-year previous smoker, social alcohol drinker, denies illicit drug use
FH
Hypertension, diabetes, hyperlipidemia, coronary artery disease on both sides of the family
Pertinent Test Results
Test | Result | Units | Normal Range |
|---|---|---|---|
WBC | 13.7 | K/uL | 3.8–11.0 103/mm3 |
Hgb | 12 | g/dL | (Male) 14–18 g/dL (Female) 11–16 g/dL |
Platelets | 286 | K/uL | 140–450 K/uL |
Sodium | 137 | mEq/L | 135–148 mEq/L |
Potassium | 3.6 | mEq/L | 3.5–5.5 mEq/L |
Chloride | 94 | mEq/L | 96–112 mEq/L |
Bicarbonate | 22 | mEq/L | 21–34 mEq/L |
BUN | 18 | mg/dL | 6–23 mg/dL |
Creatinine | 1.4 | mg/dL | 0.6–1.5 mg/dL |
Glucose | 146 | mg/dL | 65–99 mg/dL |
Lipase | 47 | U/L | 12–70 |
Troponin | <0.01 | ng/dl | <0.04 |
Lactate | 3.5 | mmol/L | <2.0 |
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