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Small bowel obstruction — MCCQE Part 1 MCQ

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ModerateAbdominal PainSmall bowel obstructionMCCQE Part 1

72-year-old woman with prior laparotomy presents with colicky abdominal pain and vomiting. She has distension, high-pitched bowel sounds and no flatus. Which of the following is the most appropriate next step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Keep nil by mouth, give IV fluids, insert NG tube if vomiting and consult surgery

Keep nil by mouth, give IV fluids, insert NG tube if vomiting and consult surgery is best because adhesions plus distension, vomiting and obstipation suggest bowel obstruction. Discharge with oral analgesia only is suboptimal because analgesia alone may mask a surgical emergency; Delay surgical assessment until routine clinic is suboptimal because time-sensitive surgical presentations require urgent assessment; Treat with laxatives or antacids as sole therapy is suboptimal because a benign gastrointestinal explanation does not account for the red flags; Perform an invasive bedside procedure without imaging or senior input is suboptimal because invasive treatment can worsen outcomes when anatomy or diagnosis is uncertain. Strangulation signs require urgent operative management.

Reference: Canadian Association of General Surgeons guidance