A 65-year-old man presents with central abdominal colic, vomiting, abdominal distension, and absolute constipation (no flatus) for 48 hours. Abdominal X-ray shows multiple air-fluid levels and distended loops of small bowel with a 'valvulae conniventes' pattern. CT abdomen shows a closed-loop obstruction. What complication is most feared in closed-loop obstruction?
- A Malabsorption
- B Bowel strangulation and ischaemia requiring urgent surgery ✓
- C Electrolyte imbalance
- D Aspiration pneumonia
Explanation
A closed-loop obstruction occurs when a segment of bowel is obstructed at two points simultaneously (e.g., internal hernia, volvulus, adhesive band trapping a loop), preventing decompression in either direction. This creates rapidly rising intraluminal pressure, compromising mesenteric blood flow and leading to bowel ischaemia, strangulation, and eventual perforation. Closed-loop obstruction is a surgical emergency — CT findings of a beak sign, whirl sign, or C/U-shaped dilated loop with mesenteric twisting indicate strangulation. Urgent surgery is required to prevent perforation and peritonitis.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.