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Small-bowel obstruction — SCE Acute Medicine MCQ

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HardAcute Gastrointestinal PresentationsSmall-bowel obstructionSCE Acute Medicine

A 51-year-old woman with previous laparotomy has vomiting and colicky pain. CT shows a C-shaped dilated small-bowel loop, two adjacent transition points, mesenteric swirl and reduced mural enhancement. Lactate is 3.8 mmol/L. What is the best next step?

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Correct answer: D — Resuscitate and proceed to emergency surgical exploration for strangulated obstruction

Explanation lettering: E = shown as A · A = shown as B · B = shown as E

D is correct. Two transition points, a C-shaped loop, mesenteric swirl, reduced enhancement and raised lactate indicate a closed-loop obstruction with threatened strangulation. Begin fluid and electrolyte resuscitation, nasogastric decompression and antibiotics according to the surgical pathway, but do not delay emergency operative assessment and exploration. A contrast challenge is for selected stable adhesive obstruction without ischaemic features. Neostigmine and colonoscopic decompression address colonic pseudo-obstruction or volvulus, not a strangulated small-bowel loop.

Reference: https://pmc.ncbi.nlm.nih.gov/articles/PMC12893134/