A 40-year-old woman who had an appendectomy 10 years ago presents with features of small bowel obstruction. CT abdomen confirms adhesive small bowel obstruction (ASBO) without signs of strangulation. What is the preferred initial management according to current EAST/Bologna guidelines?

• A Immediate operative intervention
• B Colonoscopy to decompress the bowel
• C IV steroids and antibiotics
• D Non-operative management with nasogastric decompression and gastrografin (water-soluble contrast) challenge ✓

Explanation

For uncomplicated adhesive small bowel obstruction without signs of strangulation, perforation, or closed-loop obstruction, the current standard is non-operative management (NOM) with nasogastric decompression, IV fluids, and serial clinical monitoring. The gastrografin (water-soluble contrast) challenge has both diagnostic and therapeutic benefits — if contrast reaches the colon within 24 hours, non-operative success is predicted in ~96% of cases, and the hyperosmolar agent may stimulate bowel and reduce mucosal edema. Failure of NOM at 48-72 hours or deterioration (signs of strangulation) mandates surgery.

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.