Answer

Excerpt

Although he recovered completely after the last admission he had to be readmitted within 3 days. Because he complained for the first time of abdominal pain and a palpable mass in the right distal quadrant of the abdomen was palpated, an upright abdominal X-ray was taken (Fig. 1). Multiple air-fluid levels with distended loops of small bowel could be seen, verifying the diagnosis of small bowel obstruction. Abdominal surgery was performed and revealed a huge dilated duodenum and multiple adhesions forming a conglomerate of bowel in the duodenum. The adhesions could be removed intraoperatively. After surgery his clinical condition improved, but 7 days later crampy abdominal pain and vomiting occurred again. With conservative management for several days he recovered and could be discharged in a stable condition. No further hospitalizations were necessary.

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