In a patient with small bowel obstruction (SBO) secondary to adhesions and no evidence of strangulation or perforation, which clinical or radiological feature mandates early operative intervention rather than continued non-operative management?
- A Single prior laparotomy as the cause of adhesions
- B Failure to resolve by 72 hours on water-soluble contrast follow-through ✓
- C CT showing mesenteric fat stranding without free air
- D Dilated bowel loops up to 3 cm on CT
Explanation
For adhesive SBO without signs of strangulation or ischemia, non-operative management (nasogastric decompression, IV fluids, bowel rest) with water-soluble contrast (Gastrografin) challenge is the first-line management. The contrast challenge has both therapeutic and diagnostic value—passage of contrast to the colon within 24 hours predicts spontaneous resolution. Failure of contrast to reach the colon by 72 hours is the validated criterion for operative intervention. Mesenteric fat stranding alone without ischemia signs is not an absolute indication. Isolated dilated loops up to 3 cm does not mandate surgery.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.