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Small bowel obstruction — MCCQE Part 1 MCQ

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HardNausea/VomitingSmall bowel obstructionMCCQE Part 1

A 72-year-old man with previous abdominal surgery presents with colicky abdominal pain, vomiting, and distension. He has tinkling bowel sounds and no peritonism. CT shows dilated small bowel loops with a transition point and no perforation. What is the most likely diagnosis?

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Correct answer: A — Adhesive small bowel obstruction

Prior abdominal surgery, colicky pain, vomiting, distension, and a CT transition point in the small bowel strongly suggest adhesive small bowel obstruction. Volvulus usually affects the colon and has a different imaging pattern. Gastroenteritis does not produce a transition point. Mesenteric ischaemia can cause severe pain but CT would not show a simple adhesive transition pattern without other vascular findings.

Reference: Canadian Association of General Surgeons bowel obstruction resources