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Closed-loop small bowel obstruction — RCPSC EM MCQ

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HardGI/Abdominal emergenciesClosed-loop small bowel obstructionRCPSC EM

A 74-year-old man with prior laparotomy presents with colicky abdominal pain, distension and bilious vomiting. HR is 112, lactate is 2.9 mmol/L, and CT shows small bowel obstruction with closed-loop configuration and mesenteric swirl. What is the most likely diagnosis?

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Correct answer: B — Closed-loop small bowel obstruction with strangulation risk

A closed-loop obstruction with mesenteric swirl and rising lactate suggests threatened bowel and requires urgent surgical involvement.

Reference: Royal College Emergency Medicine exam format and training experiences