A 65-year-old male with previous abdominal surgeries presents with colicky abdominal pain, abdominal distention, bilious vomiting, and obstipation. Abdominal X-ray demonstrates dilated small bowel loops (> 3 cm) with multiple air-fluid levels in a 'step-ladder' pattern. What is the most common etiology?

Answer and explanation

Correct answer: A. Postoperative peritoneal adhesions

  1. Step 1: Postoperative peritoneal adhesions account for approximately 60% to 75% of all cases of small bowel obstruction (SBO) in developed countries, far exceeding hernias, malignancy, and strictures.
  2. Step 2: Initial conservative management includes nasogastric decompression, intravenous hydration, and serial abdominal examinations.
Answer
Postoperative peritoneal adhesions.
Why not the others: 'Incarcerated femoral hernia' is the second most common cause of SBO but less frequent overall; 'Sigmoid volvulus' causes large bowel obstruction with a 'coffee-bean' sign; 'Colonic adenocarcinoma' is the leading cause of large bowel obstruction, not small bowel.

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