Question: surgery case – ID SUR1001

Category: Surgery.

64 y F with Hx of emphysema, HTN, laparoscopic hemicolectomy for Stage 2 colorectal cancer, and femoral hernia who presents with cramping abdominal pain, nausea, and vomiting. Her last bowel movement was yesterday morning. On exam, she has a distended abdomen with mild diffuse tenderness without rebound or guarding. She has a lump in her left groin which is reducible and non-tender.

Vitals: T 37.2C, HR 98, BP 138/74, SpO2 93%.
Her WBC is 10.1, Hb 11.4, BUN 39, Cr 1.1, LFTs normal. CT Abdomen / Pelvis shows dilated loops of small bowel with a transition point.

What is the appropriate management?

A) OR for exploratory laparotomy
B) Admit, make NPO and place an NGT to low continuous suction
C) OR for reduction and repair of a femoral hernia
D) Admit, make NPO and do not place an NGT
E) Admit and start a bowel regimen and give the patient an enema

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