A 50-year-old man has a small bowel obstruction secondary to adhesions. Conservative management is initiated. Which of the following clinical findings would indicate the need for URGENT surgical intervention?
- A Absence of bowel sounds on auscultation
- B Persistent tachycardia, localised tenderness, and peritonism suggesting strangulation ✓
- C Lack of improvement in 24 hours of conservative management
- D Serum amylase elevation
Correct answer: B. Persistent tachycardia, localised tenderness, and peritonism suggesting strangulation
Explanation
Signs of strangulated bowel obstruction — persistent tachycardia, localised tenderness, peritonism, fever, or leucocytosis — mandate emergency surgical exploration as strangulation leads to bowel ischaemia and necrosis within hours. Simple adhesive obstruction can be managed conservatively (nasogastric decompression, IV fluids) for up to 48-72 hours; most (60-80%) resolve. Absence of bowel sounds and mild pain alone are insufficient indications for immediate surgery.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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