Clinical Challenge 2: November, 2015

The Resolution

Diagnosis
Small bowel obstruction (Figure 2).

Learnings
The most common causes of small bowel obstruction are adhesions (from previous abdominal surgery), malignancy, hernia, and Crohn disease. Plain abdominal films do not have sufficient sensitivity to detect small bowel obstruction. The treatment of small bowel obstruction should be performed in a hospital setting, so a referral is in order. Often, a nasogastric tube or observation will be all that is required, but sometimes a patient will need surgery. Do not take a patient’s self-diagnosis of constipation as accurate; it is important to investigate further.