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Strangulated small bowel obstruction — ACEM Fellowship MCQ

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HardGI/Abdominal emergenciesStrangulated small bowel obstructionACEM Fellowship

A 66-year-old man with prior laparotomy presents to a Hobart ED, triage category 2, with colicky abdominal pain, vomiting and distension. CT shows closed-loop small bowel obstruction with reduced mural enhancement and mesenteric oedema. Lactate is 4.1 mmol/L. What is the most likely diagnosis?

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Correct answer: C — Strangulated small bowel obstruction

Closed-loop obstruction with reduced enhancement, mesenteric oedema and lactate elevation indicates strangulation requiring urgent surgery.

Reference: ACEM abdominal emergency curriculum; surgical emergency guidance