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Strangulated small bowel obstruction — RCPSC EM MCQ

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ModerateGI/Abdominal emergenciesStrangulated small bowel obstructionRCPSC EM

A 71-year-old man has abdominal distension, vomiting and obstipation after previous colectomy. CT shows closed-loop small bowel obstruction with mesenteric swirl, bowel wall thickening and reduced enhancement. Lactate is 3.9 mmol/L. What is the most likely diagnosis?

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

Closed-loop obstruction with mesenteric swirl, bowel wall thickening, reduced enhancement and elevated lactate suggests strangulation and bowel ischaemia. Urgent surgical management is required.

Reference: Canadian Association of General Surgeons principles; Rosen's Emergency Medicine