A 45-year-old woman 5 days after an open hysterectomy develops abdominal pain, distension, and vomiting. CT shows dilated small bowel loops up to 4 cm with a transition point in the right iliac fossa and collapsed distal bowel — consistent with early adhesive small bowel obstruction. She has no signs of strangulation. The most appropriate initial management is:

• A Immediate laparoscopic adhesiolysis
• B Open laparotomy and adhesiolysis
• C Colonoscopy to exclude colonic obstruction
• D Non-operative management: nasogastric tube, IV fluids, nil by mouth; urgent CT with water-soluble contrast (Gastrografin) challenge if not improving at 48 hours ✓

Explanation

Early post-operative adhesive SBO in the absence of strangulation (no fever, leukocytosis, or peritonism) is managed non-operatively with nasogastric decompression and IV fluids; 70–80% resolve spontaneously. The Gastrografin challenge (oral/NGT water-soluble contrast) at 24–48 hours is both diagnostic (failure to reach caecum in 24h predicts need for surgery) and therapeutic (osmotic effect promotes bowel function).

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.