Arab Board Surgery Clinical Practice Questions - Arab Board General Surgery Final Clinical And Oral Exam

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A 62-year-old female with a history of open abdominal hysterectomy presents with a 3-day history of colicky abdominal pain, severe bilious vomiting, progressive abdominal distension, and failure to pass flatus or stool. Abdominal examination reveals localized left lower quadrant tenderness with rebound and guarding. Contrast-enhanced CT scan of the abdomen demonstrates mechanical small bowel obstruction with two transition points along a closed loop, regional bowel wall thickening, mesenteric vascular engorgement ('mesenteric swirl'), and lack of mucosal enhancement. What is the most appropriate next step in management?

Insertion of a nasogastric tube and conservative trial with water-soluble contrast (Gastrografin) for 48 hours Emergent exploratory laparotomy Diagnostic colonoscopy to decompress the obstructed bowel CT-guided percutaneous enterostomy placement

Correct Answer:

Emergent exploratory laparotomy

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