DISCHARGE DIAGNOSES:
1. Small bowel obstruction.
2. Hypertension.
PAST MEDICAL HISTORY:
1. Hyperlipidemia.
2. History of appendectomy and tonsillectomy.
3. Hernia repair.
PROCEDURES PERFORMED:
CT of abdomen on July 6, 2010:
1. Findings suggesting high-grade mid to distal small bowel obstruction as described in the body of the report.
The etiology of which is unclear on this exam.
2. Some stranding is identified and there may be some mural thickening present; some potential vascular compromise cannot be excluded.
3. Large non-obstructing left-sided renal calculus which may represent a partial stable __________.
4. Hypertrophy of the left kidney and the right kidney appears to be relatively small and atrophic.
5. Diffuse enlargement of prostate gland with some asymmetry. An underlying prostate mass cannot be excluded.
6. Inguinal hernia containing fat only.
7. Diffuse fatty infiltration seen throughout the liver with several small subcentimeter areas of low attenuation, too small to characterize on this exam.
8. Small amount of abdominal ascites present.
9. There is also a small non-obstructing right-sided renal calculus present.
Chest x-ray shows NG tube with tip in the distal stomach.
Right __________ dilatation.
X-ray of abdomen on July 7, 2010:
1. Contrast was present in the distal small bowel and colon.
2. There is no evidence of high-grade bowel obstruction.
3. Mildly dilated loop of small bowel still present in the upper abdomen.
4. Partial low-grade obstruction cannot be excluded.
July 9, 2010: CT shows no signs of significant clinical obstruction on today's CT scan. There is a long segment of abnormal small bowel at the level of distal jejunum, secondary to inflammatory or ischemic bowel disease.
Compared to previous study July 6, 2010, the bowel wall

thickening appears increased, although there is less small bowel dilatation than on the earlier exam.
HOSPITAL COURSE: 58-year-old male had a sudden onset abdominal pain, excruciating, worse in the left lower quadrant, presented to the emergency room. Initial CT scan indicated a small bowel obstruction and surgical consultation was made and surgery was scheduled for the next day. However, patient's symptoms are greater improved and surgery was postponed. Gastrografin was given to reduce the edema of the bowel wall. The patient had no further pain and no nausea and vomiting and G-tube was pulled out. The patient, although, has severe dry mouth and lactated Ringer's was switched to half normal saline.
With that the patient felt much better. Patient is tolerating full liquid diet today and patient has no signs of bowel obstruction at this time, as mentioned above on CT scan. Patient will be discharged in a.m. with current existing medications. Patient needs further followup including prostate cancer and colonoscopy.
SUMMARY:
1. Small bowel obstruction. Surgery was aborted and patient improved. Patient is currently tolerating full liquid diet without any pain. The patient will be discharged in a.m. if Dr. Tranduc agrees.
2. Prostate cancer. Incidental finding of prostate irregularity by CT scan. Further followup is necessary.
3. Nephrolithiasis. Observation only at this time.
Patient is scheduled for colonoscopy as an outpatient by
Dr. Raju also. This will be screening colonoscopy.
Patient will be discharged home with Lipitor 20 mg daily and Norvasc 5 mg p.o. daily. Patient is to follow with Dr.
Kang as an outpatient.