A 62-year-old male with a history of hypertension, hyperlipidemia, and Crohn's disease, who underwent laparoscopic bowel resection with primary anastomosis four weeks ago, presents to the ER with 2 days of abdominal pain, constipation (no bowel movement for 2 days), and nausea/vomiting for 24 hours. An abdominal x-ray revealed distended loops of bowel greater than 3 cm, a collapsed colon, and a thickened bowel wall. The string-of-pearls sign was also identified. A CT scan of the abdomen showed delayed transit time of barium through a transition point. The patient is stable but very uncomfortable. His abdomen is distended. As a hospitalist AGACNP, you are evaluating the patient.

What is the admission diagnosis based on the information provided?

A) Postoperative abscess
B) Postoperative ileus
C) Small Bowel Obstruction (SBO)
D) Surgical Site Infection (SSI)
E) Anastomotic leak

The distended loops of bowel, collapsed colon, thickened bowel wall, and string-of-pearls sign on the x-ray, along with delayed transit time of barium on CT, support this diagnosis.

Based on the described symptoms and imaging findings of distended loops of bowel, collapsed colon, thickened bowel wall, and the string-of-pearls sign on x-ray, the most likely admission diagnosis is Small Bowel Obstruction (SBO). The CT scan findings of a delayed transit time of barium through a transition point further supports this diagnosis.

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