Report from Victoria Hospital
Prince Albert, Saskatchewan, Canada
Attending Physician: Randy Friesen
Admission Date: 2000 December 12

ADMITTING DIAGNOSIS
Bowel obstruction

HISTORY
This pleasant 42-year-old Internet entrepreneur from Prince Albert presented to the Emergency Department in the wee hours of the morning complaining of severe crampy abdominal pain and the inability to pass gas per rectum. He started having crampy abdominal pain about a month ago. At that time he though he might have "the flu", so he adjusted his diet somewhat and simply went onto soups and so on and a week or so ago his symptoms seemed to settle somewhat.

MEDICATION
None. Medication allergies, none. He is a very fit gentleman and runs long distances.

ON EXAMINATION
He is a pleasant very fit looking gentleman appearing his stated age. His lung fields are clear. The heart sounds are normal. The abdomen is muscular. Bowel sounds are increased in all quadrants, both is frequency and in pitch. There are no masses or hernias. Abdominal x-rays revealed dilated bowel loops with some air fluid levels. There may be one air fluid level in the transverse colon as well though I am not completely convinced about this. Blood tests on admission were within normal limits.

OPINION
This gentleman needs to have an operation. He has a progressive obstruction. The radiological findings and the overall history are more compatible with small bowel obstruction than with large, although I advise him that I am not certain about the site or the cause of the obstruction. He may have adhesions or there may be another cause such as a tumor. I did advise that surgery should be done urgently, after we have rehydrated him. I advised that we would start with a laparoscopic approach, but that conversion to an open procedure may be necessary based on the findings or the inability to complete surgery laparoscopically. We have advised the possibility of bowel resection and that the two most significant complications are bleeding and infection. The procedure will be done on a urgent basis.

Dr. Randy Friesen