A 65-year-old woman presents with colicky central abdominal pain, distension, and absolute constipation for 48 hours. She had a previous appendicectomy 20 years ago. CT shows dilated small bowel loops with a transition point in the right iliac fossa and no free gas. She is haemodynamically stable. Initial management should include:
- A Immediate laparotomy without further assessment
- B Hyperosmolar water-soluble contrast enema to reduce the obstruction
- C IV fluids, nasogastric decompression, analgesia, and trial of conservative management for 24–48 hours ✓
- D Discharge with oral laxatives and outpatient CT enteroclysis
Explanation
Simple adhesive small bowel obstruction (SBO) in a haemodynamically stable patient without features of strangulation (fever, tachycardia, peritonitis, leukocytosis) is managed initially with IV fluid resuscitation, nasogastric decompression, electrolyte correction, and analgesia. A 24–48 hour trial of non-operative management (NOM) resolves ~70–80% of adhesive SBO. Gastrografin contrast follow-through may be used therapeutically (reduces need for surgery) and diagnostically. Immediate surgery is for strangulation, perforation, or failure of NOM. Enema is for large bowel obstruction. Oral laxatives risk aspiration in obstruction.
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.