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Small bowel obstruction from adhesions — MCCQE Part 1 MCQ

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HardNausea/VomitingSmall bowel obstruction from adhesionsMCCQE Part 1

A 61-year-old woman with previous open hysterectomy presents with colicky abdominal pain, vomiting and distension. She has high-pitched bowel sounds, no peritonism, and CT shows dilated small bowel loops with a transition point but no ischaemia. What is the most appropriate next step in management?

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Correct answer: E — Admit for nasogastric decompression, intravenous fluids and surgical review

Adhesive small bowel obstruction without peritonitis or ischaemia is initially managed with admission, bowel rest, nasogastric decompression, IV fluids and surgical review. Colonoscopy is not used for small bowel obstruction. Emergency laparotomy is reserved for strangulation, perforation, peritonitis or failure of conservative management.

Reference: Canadian Association of General Surgeons resources