A middle-aged African American female presents to your emergency department with two days of diffuse abdominal pain, distention, nausea, emesis and watery diarrhea. She has a history of asthma and hypertension, for which she was recently started on amlodipine/benazeprilat. On physical exam she is mildly tachycardic with non-peritoneal mid-epigastric and LLQ abdominal pain. Initial laboratory investigation is unremarkable other than for mild hypokalemia. An acute abdominal series is ordered demonstrating a non-specific bowel gas pattern. You suspect a small bowel obstruction, but what might you consider given the patient’s history? Surgical adhesions? Diverticulitis?
A CT of the abdomen and pelvis is ordered demonstrating marked small bowel wall thickening. The WBC was normal. Could this be infectious? Lactate – normal, certainly unlikely ischemic. What in the patient’s history could point you towards the cause?