A 55-year-old man with previous right hemicolectomy presents with 24-hour history of colicky central abdominal pain, vomiting, abdominal distension, and absolute constipation. Plain radiograph shows multiple dilated small bowel loops with a 'stack of coins' appearance. CT abdomen confirms mechanical small bowel obstruction. What is the MOST common cause in this setting?

• A Postoperative adhesions ✓
• B Crohn's disease stricture
• C Incarcerated inguinal hernia
• D Small bowel volvulus

Explanation

Postoperative adhesions account for approximately 60-70% of all small bowel obstruction (SBO) in adults, and virtually all cases in patients with prior abdominal surgery. The right hemicolectomy history strongly points to adhesional obstruction. The Bristol score or Gastrografin challenge can guide management: most adhesional SBO resolves with conservative management (NGT decompression, IV fluids), but failure to resolve within 24-48 hours, or signs of strangulation (fever, tachycardia, localised tenderness) mandate urgent laparotomy.

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.