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Small bowel obstruction — MCCQE Part 1 MCQ

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HardAbdominal PainSmall bowel obstructionMCCQE Part 1

A 66-year-old woman with a previous laparotomy has colicky pain, bilious vomiting, distension, and obstipation. CT shows an adhesive small-bowel transition point without free air, closed-loop configuration, reduced enhancement, or pneumatosis. She has no peritonitis and is hemodynamically stable. What is the best initial plan?

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Correct answer: E — Admit, keep nil by mouth, give IV fluids, decompress as needed, and obtain surgical consultation

This is an adhesive small-bowel obstruction without current evidence of strangulation, ischemia, perforation, or peritonitis. Initial care includes admission, bowel rest, intravenous volume and electrolyte replacement, antiemetic and analgesic care, nasogastric decompression when vomiting or distension is substantial, and early surgical consultation with serial reassessment. Nonoperative management is not passive: worsening pain, peritoneal signs, fever, rising lactate, shock, or concerning imaging should prompt urgent operative management. Fibre, oral fluid loading, and loperamide can worsen obstruction or aspiration risk. Colonoscopy does not treat a CT-defined small-bowel transition point. Waiting until shock develops before involving surgery creates an avoidable delay if ischemia emerges.

Reference: Emergency Care BC, Bowel Obstruction clinical summary: https://emergencycarebc.ca/clinical_resource/clinical-summary/bowel-obstruction/