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Necrotising fasciitis — RCPSC EM MCQ

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HardInfectious disease emergenciesNecrotising fasciitisRCPSC EM

A 69-year-old with prior laparotomy has colicky pain, vomiting, fever and hypotension. CT shows a closed-loop small-bowel obstruction with reduced bowel-wall enhancement and mesenteric swirl. What is the most appropriate management?

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Correct answer: C — Resuscitate, give antibiotics and obtain immediate surgical review

The best answer is “Resuscitate, give antibiotics and obtain immediate surgical review”. Closed-loop obstruction with reduced enhancement and systemic deterioration suggests bowel compromise. Give fluids and electrolyte support, keep the patient nil by mouth, use antibiotics when ischaemia or perforation is suspected, and obtain immediate surgical exploration. A contrast challenge or conservative pathway is reserved for selected uncomplicated adhesive obstruction and is unsafe here.

Reference: Emergency Care BC: Bowel Obstruction: https://emergencycarebc.ca/clinical_resource/clinical-summary/bowel-obstruction/