ZyraDoc #42 - September 12, 2026

A 62-year-old female with a history of an open appendectomy 15 years ago presents to the emergency department with severe, colicky abdominal pain, persistent bilious vomiting, and abdominal distension.

She reports an inability to pass flatus or stool (obstipation) for the past 24 hours, and physical examination reveals diffuse abdominal tenderness, high-pitched hyperactive bowel sounds with metallic rushes, and tympany to percussion.

An abdominal radiograph shows multiple dilated loops of small bowel with air-fluid levels and an absence of distal colonic gas, confirming acute mechanical small bowel obstruction.

Case Summary

Clinical Focus:

The diagnosis is Acute Small Bowel Obstruction (SBO).

Aetiology/Cause:

Postoperative intra-abdominal adhesions, accounting for approximately 60% to 75% of all mechanical small bowel obstructions.
Incarcerated or strangulated abdominal wall and groin hernias.
Intrinsic bowel pathology including Crohn's disease strictures, primary or metastatic intestinal malignancies, and intussusception or volvulus.

Clinical Features:

Sudden onset of severe, paroxysmal, colicky mid-abdominal pain accompanied by early bilious or feculent vomiting.
Progressive abdominal distension associated with obstipation (complete failure to pass flatus or feces).
Auscultatory findings of hyperactive, high-pitched tinkling bowel sounds and rushes in early obstruction, transitioning to absent bowel sounds as ileus or necrosis develops.
Signs of dehydration, tachycardic strain, and localized abdominal guarding or rebound tenderness indicating potential strangulation.

Diagnosis and Investigations:

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