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Small bowel obstruction — USMLE Step 3 MCQ

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ModerateSurgery (post-operative, follow-up)Small bowel obstructionUSMLE Step 3

A 66-year-old man with prior laparotomy has crampy abdominal pain, vomiting, and obstipation. Abdomen is distended but without peritonitis. CT shows dilated small bowel loops with a transition point and no ischemia or perforation. Vital signs are stable. 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: D — Begin nasogastric decompression, intravenous fluids, and surgical observation

Adhesive small bowel obstruction without strangulation is initially managed with bowel rest, fluids, decompression, and close surgical monitoring.

Reference: Surgical management of small bowel obstruction guidance: https://www.facs.org/