small bowel obstruction - m0304

[ArchivalUser]

One of the NBME questions called for inital step in management of what looked like a small bowel obstruction... 37 yr old woman with abdominal distention and distant history of hysterectomy. Xray showed big dilated loops of colon...the choices were 1)laporotomy 2) gastroduodenoscopy 3) CT abdomen...

Is there a confirmatory test? or would you just open her up?

[ArchivalUser]

X rays are sufficient showing obstruction in this case as a result of surgery. It won't resolve spontaneously and she need s surgery.

[ArchivalUser]

it depends on severity of symtoms at presentation
xrays already made the diagnosis along with history
now if she has acute abdomen we will suspect ischemic bowel and laprotomy is done
chances of perforation leading to long term post op management
but if the symtoms are not severe we can keep her npo , ng suction and supportive therapy

[ArchivalUser]

this patient was not in any acute distress. do we need to do a CT to rule out any other cause of obstruction like mass lesion? I think i'm over thinking it, the answer was probably laporotomy. thanks.

[ArchivalUser]

You suspect etiology based on the history here (surgery), so you don't need more diagostics.