A 67-year old man presented with a 24-hour history of crampy abdominal pain, nausea and vomiting. He had had a prior appendectomy. Examination revealed a tender fullness in the right lower quadrant without peritoneal signs. The abdominal X-ray shows dilated loops of jejunum, characterized by the semicircular mucosal folds, in the upper abdomen, and absence of gas elsewhere.
The abdomen was not distended, which is characteristic of a high small bowel obstruction. Because the patient evidenced complete small bowel obstruction with localizing findings, he was taken immediately to the operating room.
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