allergies: codeine / zestril attending: chief complaint: abdominal pain. major surgical or invasive procedure: exploratory laparotomy with lysis of adhesions history of present illness: mr. is a pleasant 57 yo white male well known to this service, who has a rather complicated pmh, including s/p bowel resection for non-hodgkin's b-cell lymphoma of the small bowel, recently treated conservatively in for partial small bowel obstruction, who presented to on , with complaints of abdominal pain with nausea vomiting. past medical history: non-hodgkin's lymphoma congential lymphatic atresia seminoma s/p radiation and resection appendectomy, perforated cholecystectomy sbo () s/p resection social history: supportive wife, otherwise denies /etoh/idu. family history: father - pvd mother - questionable metastatic ovarian cancer physical exam: general: alert, oriented, well-nourished, whincing in pain heent: anicteric; no jvd lad or thyromegaly chest: cta bilaterally cv: rrr without murmur or 3rd heart sound noted abd: mildly distended, soft, diffusely tender ext: profound bilateral lower extremity edema, distal neurovascular intact brief hospital course: as above, mr. , with a history of partial small bowel obstruction and non-hogdkin's b cell lymphoma of small bowel, s/p resection, presented to on with complaints of abdominal pain with nausea and bilious vomiting. a ct scan of the abdomen revealed a small bowel obstruction with a clear transition. he was admitted to the surgery service. he was made npo, an ng tube was placed, he was hydrated well, and treated conservatively for 2 days. it was apparent that mr. bowel obstruction was not resolving, and on , he underwent an exploratory laparotomy with lysis of adhesions to resolve his bowel obstruction. he tolerated the procedure well. however, because of his lymphatic atresia, mr. is unable to adequately keep fluid in his intravascular space, and he required aggressive hydration, much of which was simply "third spaced" into his soft tissue space. he became incredibly edematous, and he remained intubated in the pacu for some time. he eventually was extubated, which he tolerated well. his recovery, while uncomplicated, was slowed by his edema. he began working with physical therapy. his diet was advanced slowly, and it was quite evident that his bowel obstruction was relieved by his operation. he eventually ambulated easily and often on his own. before discharge, his diet was advanced to regular, his pain was well controlled with oral pain medications, and his wound appeared well healing. he was discharged to home in good condition on . discharge medications: 1. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. disp:*45 tablet(s)* refills:*0* 2. fluticasone-salmeterol 100-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 3. albuterol-ipratropium 103-18 mcg/actuation aerosol sig: puffs inhalation q6h (every 6 hours) as needed. 4. ipratropium bromide 18 mcg/actuation aerosol sig: two (2) puff inhalation qid (4 times a day). 5. glyburide 5 mg tablet sig: one (1) tablet po daily (daily). 6. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q6h (every 6 hours) as needed. 7. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 8. insulin regular human 100 unit/ml solution sig: one (1) injection asdir (as directed). 9. zolpidem tartrate 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed. disp:*30 tablet(s)* refills:*0* 10. keflex 250 mg capsule sig: one (1) capsule po four times a day for 5 days. disp:*20 capsule(s)* refills:*0* 11. colace 100 mg capsule sig: one (1) capsule po twice a day. disp:*60 capsule(s)* refills:*2* discharge disposition: home discharge diagnosis: small bowel obstruction non-hodgkins b cell lymphoma discharge condition: good discharge instructions: please keep wound area clean and dry. take all medications as prescribed. seek medical attention if you experience fever, chills, nausea, vomiting or increased abdominal pain. followup instructions: please call dr. at within the first few days following discharge to schedule a follow-up appointment. Procedure: Venous catheterization, not elsewhere classified Parenteral infusion of concentrated nutritional substances Other lysis of peritoneal adhesions Application or administration of an adhesion barrier substance Diagnoses: Unspecified protein-calorie malnutrition Other malignant lymphomas, unspecified site, extranodal and solid organ sites Disturbance of skin sensation Personal history of other diseases of circulatory system Paralytic ileus Pressure ulcer, buttock Volvulus Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection) Hereditary edema of legs