A 65-year-old female presents with colicky abdominal pain, vomiting, and abdominal distention for 2 days. X-ray shows dilated small bowel loops with air-fluid levels. Oral contrast CT shows a beaked point in the small bowel transition zone. Past history includes two prior lower abdominal surgeries. What is the most likely cause of small bowel obstruction?
- A Gallstone ileus
- B Incarcerated inguinal hernia
- C Adhesions from previous surgery ✓
- D Strangulated femoral hernia
Correct answer: C. Adhesions from previous surgery
Explanation
Post-operative adhesions are the most common cause of small bowel obstruction in developed countries, accounting for approximately 60–70% of all cases. The history of two prior abdominal surgeries with dilated small bowel and a transition zone on CT strongly supports adhesional SBO. Gallstone ileus would typically show the Rigler's triad (SBO, ectopic gallstone, pneumobilia). Hernias would be evident on clinical examination and CT. Initial management is typically non-operative for partial adhesional SBO.
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.