A 70-year-old man presents with complete small bowel obstruction following previous sigmoid colectomy 10 years ago. CT abdomen shows a transition point in the mid-ileum with closed-loop obstruction. Despite 24 hours of nasogastric decompression, he has not improved and develops peritonism. The most appropriate management is:
- A Emergency surgical exploration; closed-loop obstruction with peritonism indicates strangulation ✓
- B Continue conservative management for another 48-72 hours; adhesional SBO resolves in 85% of cases
- C Water-soluble contrast follow-through to predict need for surgery
- D Gastrografin enema to relieve the obstruction therapeutically
Explanation
Closed-loop obstruction (two-point obstruction with a trapped bowel segment) is a surgical emergency with a high risk of strangulation and rapid progression to ischemia and perforation; it does not respond to conservative management. The development of peritonism (peritoneal irritation from transmural ischemia or perforation) is an absolute indication for emergency surgical exploration. The Gastrografin challenge is appropriate only for suspected partial adhesional SBO without signs of strangulation; water-soluble contrast has both diagnostic and therapeutic roles but not in this presentation.
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.