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A New Diagnostic Sign in Small-Bowel Obstruction

John H. Sewak, MD
JAMA. 1965;194(8):935. doi:10.1001/jama.1965.03090210099039.
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To the Editor:—  Several years ago, I was examining a patient with an acute abdomen. As part of the examination, I attempted to demonstrate a fluid wave to determine the presence of free peritoneal fluid. As I turned the patient from one side to the other, the patient complained of more severe pains just after being turned on either side. Surgery was performed on this patient, and the finding was a small-bowel obstruction, with fluid-filled loops and very little air in the small bowel. It occurred to me that the weight of the fluid-filled loops would produce a pulling on the root of the mesentery when the patient was turned from side to side thereby producing a severe pain.In the ensuing cases that I encountered, this sign appeared to be present when fluid-filled loops of small bowel were present in the cases in which there was an obstruction.One


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