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Gynaecology & Obstetrics
A 32-year-old G2P1001 at 20 weeks gestational age presents to the emergency room complaining of constipation and abdominal pain for the past 24 h. The patient also admits to bouts of nausea and emesis since eating a very spicy meal at a new Thai restaurant the evening before. She denies a history of any medical problems. During her last pregnancy, the patient underwent an elective cesarean section at term to deliver a fetus in the breech presentation. The emergency room doctor who examines her pages you and reports that the patient has a low-grade fever of 100degF, with a normal pulse and blood pressure. She is minimally tender to deep palpation with hypoactive bowel sounds. She has no rebound tenderness. The patient has a WBC of 13,000, and electrolytes are normal. What is the appropriate next step in the management of this patient?
The history and physical exam are consistent with constipation, which is commonly associated with pregnancy; the patient should be discharged with reassurance and instructions to give herself a soapsuds enema and follow a high-fiber diet with laxative use as needed
The patient should be prepped for the operating room immediately to have an emergent appendectomy
The patient should be reassured that her symptoms are due to the spicy meal consumed the evening before and should be given Pepto-Bismol to alleviate the symptoms
The patient should be sent to radiology for an upright abdominal x-ray
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