A 64-year-old woman presents to the urgent care center with 24 hours of crampy abdominal pain, abdominal distention, nausea, and multiple episodes of vomiting. Her medical history is significant for a degenerative joint disease and a total abdominal hysterectomy performed 15 years ago. She does not take any medications. Temperature is 37.1°C (98.8°F), blood pressure is 128/76 mm Hg, pulse is 102/min, and respiratory rate is 18/min. Physical examination reveals a distended abdomen with diffuse tenderness and high-pitched bowel sounds. Abdominal radiography demonstrates multiple dilated loops of small bowel with air-fluid levels.
Which of the following is the most likely cause of this patient’s condition?
The correct answer is:
B: Adhesions from prior surgery.
This patient has a classic presentation of small bowel obstruction. In developed countries, postoperative adhesions are the most common cause of small bowel obstruction. Her prior abdominal surgery substantially increases the likelihood of adhesive disease.
Answer choice A: Acute pancreatitis, is incorrect.
Pancreatitis can cause abdominal pain and ileus but does not typically produce mechanical obstruction with air-fluid levels and a history of prior surgery.
Answer choice C: Cholecystitis, is incorrect.
Cholecystitis presents with right upper quadrant pain and does not usually cause bowel obstruction.
Answer choice D: Crohn disease, is incorrect.
Crohn disease can cause strictures that lead to obstruction. However, this patient has no history suggesting inflammatory bowel disease, whereas she has a strong risk factor for adhesive obstruction.
Answer choice E: Ulcerative colitis, is incorrect.
Ulcerative colitis rarely causes small bowel obstruction because it is limited to the colon and rectum.
Key Learning Point
Postoperative adhesions are the most common cause of small bowel obstruction in developed countries.
