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Strangulated small bowel obstruction — RCPSC EM MCQ

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HardGI/Abdominal emergenciesStrangulated small bowel obstructionRCPSC EM

A 55-year-old man with prior laparotomy has colicky abdominal pain, vomiting, and distension. CT shows small bowel obstruction with closed-loop configuration, reduced bowel wall enhancement, and mesenteric swirl. Lactate is 3.6 mmol/L. What is the most likely diagnosis?

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Correct answer: C — Strangulated closed-loop small bowel obstruction

Closed-loop obstruction, reduced enhancement, mesenteric swirl, and elevated lactate suggest strangulation and ischaemia. This is a surgical emergency.

Reference: Canadian emergency surgery practice; radiology appropriateness guidance