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Bowel obstruction — SCE Acute Medicine MCQ

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ModerateAcute GI PresentationsBowel obstructionSCE Acute Medicine

A 64-year-old man is assessed on the acute medical unit. He has colicky abdominal pain, vomiting, distension and previous abdominal surgery. Bowel sounds are high pitched and lactate is normal. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate investigation?

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Correct answer: D — CT abdomen and pelvis with contrast

CT abdomen and pelvis with contrast is the best answer because CT defines the site, cause and complications of suspected bowel obstruction. MRI brain with diffusion-weighted imaging is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Plain films may miss strangulation or closed-loop obstruction.

Reference: https://cks.nice.org.uk/#acute-medicine-order-56-1