In adhesion-related small bowel obstruction (SBO), which clinical/radiological sign mandates immediate surgical intervention rather than trial of non-operative management?
- A Closed-loop obstruction with twisting of bowel on CT (C-shaped or whirlpool sign) ✓
- B Nausea and vomiting with abdominal distension
- C Water-soluble contrast (Gastrografin) appearing in the colon at 24 hours
- D Dilated small bowel loops of 3.5 cm on CT
Explanation
Closed-loop obstruction (identified on CT by a U-shaped or C-shaped bowel loop with convergence of the mesentery — 'whirlpool sign' or 'beak sign') indicates a segment of bowel obstructed at two points simultaneously with compromised vascular supply, carrying high risk of strangulation and perforation within hours. This is an absolute surgical emergency regardless of vital signs. Non-operative management (NG tube, IV fluids, Gastrografin challenge) is appropriate ONLY for partial or incomplete adhesive SBO without signs of strangulation. Gastrografin reaching the colon at 24 hours predicts resolution and can safely avoid surgery.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.