116.A 71-year-old man presents to the ED with diffuse, crampy abdomi-
nal pain that began 1 hour after eating lunch today. The pain is intermittent
over the last 8 hours with increasing severity. He also complains of nausea
and chills, and vomited once on his way to the ED. He has not had a bowel
movement or flatus since the pain began. His past medical history includes
prostate cancer, left total hip replacement, appendectomy 25 years ago, right
iliac artery aneurysm repair 5 years ago, incisional hernia repair 4 years ago,
and irritable bowel syndrome. Which of the following is the most common
cause of SBO in adults?
a. Bezoar
b. Neoplasm
c. Incarcerated hernia
d. Gallstone ileus
e. Adhesion
117.An 18-year-old man presents to the ED with nausea and vomiting
complaining of testicular pain for the past hour that began while playing
volleyball. He recalls having similar pain 1 week ago that resolved sponta-
neously after 10 minutes. He was recently well and reports no fever, diar-
rhea, urinary frequency, or dysuria. Physical examination reveals vital signs
within normal limits. The patient appears in moderate discomfort, holding
his scrotum. His abdomen is soft and nontender. His right hemiscrotum is
swollen, erythematous, and diffusely tender. It is not possible to palpate
the testis separate from the epididymis. The right cremasteric reflex is
absent. His left testis has a horizontal lie and is nontender. You suspect tes-
ticular torsion. What is the correct way to attempt manual detorsion?
a. Elevate the painful testis until there is pain relief.
b. Rotate the testes in a lateral to medial direction as if you were closing a book.
c. Rotate the testes in a medial to lateral direction as if you were opening a book.
d. Rotate the testes in an inferior to superior direction.
e. Rotate the testes in a superior to inferior direction.
Abdominal and Pelvic Pain 101