54-year-old woman comes to the emergency department due to 2 days of abdominal pain. She has also had anorexia, nausea,
hiccups, and shortness of breath. The patient was diagnosed with acute appendicitis and underwent a laparoscopic appendectomy
10 days ago. She had been recovering well until the abdominal pain returned. The patient has a history of type 2 diabetes mellitus
and prior cholecystectomy for choleliths. Temperature is 39.3 C (102.8 F), blood pressure is 120/70 mm Hg, pulse Is 94/min, and
respirations are 24/min. BMI is 30 kg/m2. No scleral icterus or skin rash is present Breath sounds are decreased at the right base.
The abdomen is mildly distended, and palpation of the right upper quadrant elicits pain. The abdominal surgical incisions are mildly
tender without surrounding erythema or discharge. Bowel sounds are decreased. Leukocyte count is 24,000/mm3
, and chest x-ray
reveals a right pleural effusion. Which of the following is the most likely cause of this patient’s current condition?
- Q A. Choledochohthiasis
- 0 B. Hospital-acquired pneumonia
- 0 C . Intra-abdominal abscess
- 0 0. Mechanical bowel obstruction
- 0 E. Postoperative atelectasis
- 0 F. Pulmon ary embolism