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A 52-year-old man undergoes an elective sigmoid resection with primary colorectal anastomosis

52 years old | Male

Vignette:

A 52-year-old man undergoes an elective sigmoid resection with primary colorectal anastomosis for chronic diverticulitis. The operative course is routine. Postoperatively, he starts on a clear-liquid diet and receives morphine via patient-controlled analgesia pump. On the second postoperative day, he has a distended abdomen, is nauseated, and has not passed flatus. He vomits repeatedly and requires nasogastric decompression. Abdominal x-ray shows uniform small bowel distention with some air in the colon.

Summary:

chronic diverticulitis | Postoperatively | abdominal surgery | distended abdomen | nauseated | no passed flatus | vomits repeatedly | nasogastric decompression | uniform small bowel distention | some air in the colon

Dx:

Ileus

Ref:

https://online.epocrates.com/diseases/99522/Ileus/Common-Vignette

Rank

Disease

Weight

1 Ruptured ectopic pregnancy 353.0
2 Gastroparesis 352.0
3 Sigmoid volvulus 344.0
4 Intestinal Obstruction 325.0
5 Hereditary Angioedema 292.0
6 Giardiasis 280.0
7 Ileus 273.0
8 Ovarian Cancer 236.0
9 Premenstrual syndrome 234.0
10 Acute Pancreatitis 219.0
11 Gastric Outlet Obstruction 212.0
12 Ovarian Hyperstimulation Syndrome 201.0
13 Foreign body ingestion 194.0
14 Lactose intolerance 189.0
15 Acute peptic ulcer 188.0
16 Dyspepsia 185.0
17 Acute intermittent porphyria 181.0
18 Liver disease 180.0
19 Gastritis 173.0
20 Mesenteric ischemia 169.0
21 Bacterial pharyngitis 166.0
22 Abdominal compartment syndrome 164.0
23 Acute Appendicitis 162.0
24 Intestinal Pseudo Obstruction 162.0
25 Ovarian Torsion 161.0
26 Food poisoning 160.0
27 Ectopic Pregnancy 155.0
28 Alcoholic Liver Disease 152.0
29 Intussusception 151.0
30 Hiatus hernia 151.0
31 Pyogenic Liver Abscess 150.0
32 Diverticulitis 148.0
33 Irritable Bowel Syndrome 145.0
34 Biliary cirrhosis 145.0
35 Liver Cirrhosis 145.0
36 Alcoholic hepatitis 141.0
37 Gallstone pancreatitis 140.0
38 Klebsiella pneumoniae liver abscess 139.0
39 Acute perforated appendicitis 136.0
40 Toxic Megacolon 136.0
41 Gastric Volvulus 133.0
42 Alcoholic Liver Cirrhosis 133.0
43 Celiac Disease 133.0
44 Acute Cholecystitis 128.0
45 Meckel diverticulum 128.0
46 Ascites 127.0
47 Inguinal hernia 125.0
48 mucosal Eosinophilic gastroenteritis 122.0
49 Travelers diarrhea 120.0
50 Muscle Layer Eosinophilic gastroenteritis 119.0
51 Emphysematous cholecystitis 118.0
52 Umbilical hernia 118.0
53 Gallstones 117.0
54 Leiomyomas 117.0
55 Kidney stones 116.0
56 Migraine headache in adults 113.0
57 Crohn Disease 112.0
58 Primary biliary cirrhosis 112.0
59 Systemic sclerosis 112.0
60 Clostridium difficile infection 107.0
61 Peutz-Jeghers Syndrome 107.0
62 Sialadenitis 106.0
63 Intraperitoneal bleeding 106.0
64 Non-ST-elevation myocardial infarction 102.0
65 Primary sclerosing cholangitis 102.0
66 Choledocholithiasis 100.0
67 Type 1 Diabetes mellitus 100.0
68 Acute Liver Failure 99.0
69 Gastric cancer 98.0
70 Acute fatty liver of pregnancy 98.0
71 Intra-abdominal abscess 97.0
72 Adrenal crisis 97.0
73 Osteoporosis 96.0
74 Gallbladder cancer 95.0
75 Liver Abscess 90.0
76 Amebic Liver Abscess 90.0
77 Alcoholic Fatty Liver 90.0
78 Autoimmune hepatitis 90.0
79 Anthrax 90.0
80 Diabetes Mellitus 89.0
81 Tuberculous Peritonitis 88.0
82 Acute Lymphoblastic leukemia in children 88.0
83 Rocky Mountain spotted fever 88.0
84 Urinary Tract Obstruction 83.0
85 Acute pyelonephritis in adults 83.0
86 Spontaneous bacterial peritonitis 82.0
87 Painless thyroiditis 82.0
88 ST-elevation myocardial infarction 80.0
89 Ulcerative Colitis 79.0
90 Intestinal malrotation 79.0
91 Acetaminophen overdose 76.0
92 Addison Disease 76.0
93 Cholangiocarcinoma 75.0
94 Peptic Ulcer 75.0
95 Gallbladder Dyskinesia 74.0
96 Thrombotic thrombocytopenic purpura 72.0
97 pancreatic cancer 71.0
98 Analgesic nephropathy 71.0
99 Chronic Pancreatitis 70.0
100 Brucellosis 69.0
101 Chronic heart failure 68.0
102 Exocrine pancreatic insufficiency 68.0
103 Motion Sickness 68.0
104 Duodenal Ulcer 66.0
105 Gastric Ulcer 66.0
106 Hyperparathyroidism 66.0
107 Chronic pelvic pain in women 66.0
108 Non-cholera Vibrio infections 66.0
109 Acute Clonorchiasis 65.0
110 Acute Hepatitis 65.0
111 Sphincter of Oddi Dysfunction 65.0
112 biliary SOD 65.0
113 pancreatic SOD 65.0
114 Aseptic meningitis 65.0
115 Hemolytic uremic syndrome 64.0
116 Inflammatory Bowel Diseases 63.0
117 Systemic lupus erythematosus 62.0
118 Migraine 62.0
119 Henoch-Schonlein purpura 61.0
120 Type 2 Diabetes mellitus 61.0
121 Pyelonephritis 61.0
122 Familial Mediterranean fever 60.0
123 Campylobacter infection 60.0
124 Choledochal Cyst 60.0
125 Foodborne E coli infection 59.0
126 Pancreatic Pseudocyst 59.0
127 Hepatocellular carcinoma 59.0
128 Hyperthyroidism 59.0
129 Hypertriglyceridemia 59.0
130 Amyloidosis 59.0
131 Labyrinthitis 59.0
132 Panic disorder in adults 59.0
133 Autosomal Recessive Polycystic Kidney Disease 58.0
134 Ovarian and fallopian tube torsion 58.0
135 Colorectal cancer 56.0
136 Wilson disease 56.0
137 Gastroesophageal reflux disease 55.0
138 Common cutaneous drug reactions 55.0
139 Diabetic Ketoacidosis 55.0
140 Angle Closure Glaucoma 55.0
141 subserosal eosinophilic gastroenteritis 54.0
142 Sarcoidosis 54.0
143 Endometrial cancer 54.0
144 Graves Disease 54.0
145 Eosinophilic gastroenteritis 53.0
146 Annular pancreas 53.0
147 Diabetic Neuropathy 53.0
148 Secondary Peritonitis 53.0
149 Hepatorenal Syndrome 52.0
150 Autosomal Dominant Polycystic Kidney Disease 51.0
151 Hyperprolactinemia 51.0
152 Papilledema 51.0
153 Budd Chiari Syndrome 50.0
154 Malt lymphoma 50.0
155 End Stage Renal Disease 50.0
156 Anaphylaxis 50.0
157 Milk-alkali syndrome 50.0
158 Acute Milk-alkali syndrome 50.0
159 Chronic Milk-alkali syndrome 50.0
160 Breast Cancer 50.0
161 Subdural hematoma 50.0
162 Intestinal Entamoeba histolytica amebiasis 48.0
163 Heparin-induced thrombocytopenia 48.0
164 Ankylosing spondylitis 48.0
165 Primary Myelofibrosis 46.0
166 Hypercalcemia 46.0
167 Acute viral meningitis 46.0
168 Chronic pyelonephritis 46.0
169 Amphetamine use disorder 46.0
170 Chronic bacterial prostatitis 46.0
171 Multiple endocrine neoplasia 2A 45.0
172 Shigellosis 44.0
173 Hereditary hemochromatosis 44.0
174 Short bowel syndrome 44.0
175 biliary colic 44.0
176 Viral Gastroenteritis 44.0
177 Acute disseminated encephalomyelitis 44.0
178 Polyarteritis nodosa 44.0
179 Non-small cell lung cancer 44.0
180 Esophagitis 42.0
181 Peritoneal dialysis associated peritonitis 41.0
182 Listerial gastroenteritis 41.0
183 Adrenal Suppression 41.0
184 Salmonella infection 41.0
185 Typhoid infection 41.0
186 Fungal meningitis 41.0
187 Chronic liver disease 40.0
188 Portal hypertension 40.0
189 Acute peritonitis 40.0
190 Chronic Mitral regurgitation 40.0
191 Acute heart failure 40.0
192 Meniere disease 40.0
193 Secondary hyperparathyroidism 38.0
194 Infectious mononucleosis 38.0
195 Cystic Fibrosis 36.0
196 Malaria 36.0
197 Acalculous Cholecystitis 35.0
198 Hypothyroidism 35.0
199 Acute Lymphocytic Leukemia in Adults 35.0
200 chronic acalculous cholecystitis 34.0
201 Hemorrhagic stroke 34.0
202 Ischemic stroke 34.0
203 Acromegaly 34.0
204 Bacterial gastroenteritis 34.0
205 Prinzmetal angina 34.0
206 Unstable angina 34.0
207 Intrahepatic cholestasis of pregnancy 34.0
208 Diabetic Kidney Disease 34.0
209 Gilbert syndrome 33.0
210 Splenic Infarction 32.0
211 Acute pericarditis 32.0
212 Acute bacterial meningitis in adults 32.0
213 Pheochromocytoma 30.0
214 Non-alcoholic Fatty Liver Disease 29.0
215 Mitral Stenosis 29.0
216 Psychogenic polydipsia 29.0
217 Stable angina 28.0
218 Insect bites and stings 27.0
219 Multiple endocrine neoplasia 2B 27.0
220 Stable ischemic heart disease 26.0
221 Sunburn 26.0
222 Chronic Clonorchiasis 24.0
223 Renal Cell Carcinoma 23.0
224 Kawasaki disease 23.0
225 Discogenic low back pain 22.0
226 Rumination Syndrome 21.0
227 Autoimmune Pancreatitis 20.0
228 Chronic Lymphocytic Leukemia 20.0
229 Pneumonia 20.0
230 Herpes zoster 19.0
231 Extraintestinal Entamoeba histolytica amebiasis 18.0
232 Acute Cholangitis 18.0
233 Chronic Cholecystitis 18.0
234 anterior ischemic optic neuropathy 18.0
235 Periorbital and orbital cellulitis 18.0
236 Acute bacterial rhinosinusitis 18.0
237 Familial adenomatous polyposis syndrome 18.0
238 Cryptococcosis 18.0
239 Gout 16.0
240 Anaplastic thyroid cancer 16.0
241 Cushing syndrome 16.0
242 Epiploic appendagitis 15.0
243 Ruptured Tuboovarian abscess 14.0
244 Granulomatosis with polyangiitis 14.0
245 Chronic Hepatitis 13.0
246 COVID19 12.0
247 Glomerulonephritis 12.0
248 Rheumatoid Arthritis 12.0
249 Hypoparathyroidism 12.0
250 Acute Myeloid Leukemia in adults 12.0
251 Hypogammaglobulinemia 11.0
252 Medullary thyroid cancer 11.0
253 Renal and perinephric abscess 11.0
254 Lung Cancer 11.0
255 Acute otitis media 11.0
256 Toxic thyroid adenoma 11.0
257 Mirizzi Syndrome 10.0
258 Testicular cancer 10.0
259 Influenza 10.0
260 Multiple Myeloma 9.0
261 Acute respiratory failure 9.0
262 Aortic coarctation 9.0
263 Clonorchiasis 8.0
264 Splenic abscess 8.0
265 Churg-Strauss Syndrome 8.0
266 Guillain-Barre syndrome 8.0
267 Zollinger-Ellison Syndrome 7.0
268 Paraneoplastic Syndromes 7.0
269 Achalasia 7.0
270 Drowning 7.0
271 Aortic stenosis 7.0
272 Obstructive Sleep Apnea 6.0
273 Asthma 6.0
274 Aortic Dissection 6.0
275 Anemia of chronic disease 6.0
276 Primary ciliary dyskinesia 5.0
277 Kartagener syndrome 5.0
278 Cholera 5.0
279 Bed bugs 5.0
280 Dacryocystitis 5.0
281 Chronic Myeloid Leukemia 5.0
282 Limited cutaneous systemic sclerosis 5.0
283 Adrenocortical carcinoma 4.0
284 Fibromyalgia 4.0
285 Pulmonary Embolism 4.0
286 Acute atrial fibrillation 4.0
287 Common cold(adults) 3.0
288 Acute bacterial meningitis in children 3.0
289 Acute Bronchitis 2.0
290 Diabetic Amyotrophy 2.0
291 Hyperaldosteronism 1.0
292 Abetalipoproteinemia 0.0
293 Conjunctivitis 0.0
294 Epidemic keratoconjunctivitis 0.0
295 Bacterial conjunctivitis 0.0
296 Viral conjunctivitis 0.0
297 Allergic conjunctivitis 0.0
298 Ligneous conjunctivitis 0.0
299 Vernal keratoconjunctivitis 0.0
300 Atopic keratoconjunctivitis 0.0
301 Noninfectious nonallergic conjunctivitis 0.0
302 Hyperosmolar Hyperglycemic state 0.0
303 Acute epididymitis 0.0
304 Immune thrombocytopenia 0.0
305 Acute Cystitis(Men) 0.0
306 Recurrent aphthous stomatitis 0.0
307 Transient ischemic attack 0.0