A 70-year-old man with previous abdominal surgery presents with central colicky pain, abdominal distension, absolute constipation, and bile-stained vomiting for 24 hours. Abdominal X-ray shows dilated small bowel loops with a ladder pattern and no gas in the colon. What is the most likely cause of the obstruction?
- A Colonic carcinoma
- B Volvulus
- C Adhesions from previous surgery ✓
- D Hernia
Correct answer: C. Adhesions from previous surgery
Explanation
Adhesions from previous abdominal or pelvic surgery account for approximately 60-70% of all small bowel obstructions in adults in developed countries. Characteristically, the X-ray shows dilated small bowel (valvulae conniventes spanning the full width) and absent colonic gas. Initial management is nasogastric decompression, IV fluids, and electrolyte correction with serial clinical assessment. Surgery is indicated for failure of conservative management, closed-loop obstruction, or signs of strangulation.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.