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Small-bowel obstruction — ABEM Board MCQ

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ModerateGI/Abdominal emergenciesSmall-bowel obstructionABEM Board

A 66-year-old man with prior colectomy arrives with crampy abdominal pain and vomiting. Triage acuity is ESI 3; BP 132/80 mm Hg, HR 104/min. Abdomen is distended with high-pitched bowel sounds and diffuse tenderness without peritonitis. CT shows dilated small bowel with a transition point. Which of the following is the most appropriate next step in management?

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

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Correct answer: E — Keep him NPO, place a nasogastric tube, give IV fluids, and consult surgery

Adhesive small-bowel obstruction is managed with bowel rest, decompression, fluids, and surgical consultation, with urgent surgery if strangulation is present.

Reference: ACS emergency surgery guidance