weekly_question 26/11/2023

[Admin]

A 14-year-old girl with a history of multiple abdominal operations presents with nausea, vomiting, abdominal pain, distention and obstipation. She is hemodynamically stable and has received intravenous fluids. A nasogastric tube has been placed. Her abdominal x-ray demonstrates dilated loops of small bowel. The best next step in management is:

A admission for serial abdominal exams and imaging

B laparotomy

C laparoscopic exploration

D contrast challenge via the NG tube

E contrast enema

[Admin]

correct answer
D contrast challenge via the NG tube

Several retrospective studies have demonstrated that a water-soluble contrast challenge is safe and effective in the non-operative management of children with adhesive small bowel obstructions and can be successful in reducing operative intervention. Abdominal exploration would be indicated if there was peritonitis, pneumoperitoneum or failed non-operative management. A contrast enema would not likely be helpful.

[Ismailmohamed]

A

[Drobadamaher]

C, the best
I think need to go for laparoscopic explanation because it's had multiple operations.
Possible of adhesive or internal hernia

[Baashe]

A

[M Abdelbary]

If not tender abdomem, which was not mentioned in the scenario,
will try NG contrast(gastrograffin) adhesiolysis

[Bilal]

D

[zeezuliving]

the options are quite tricky...I would manage this patient non operatively with suck and drip..and if i need to intervene if obstruction is not relieved after 48hours,ill attempt C ..laparoscopy which might be difficult ...so eventually might need a laparotomy to do the adhesiolysis

[Muhammad uzair]

Option A

[Faisal Ali]

A

[Faisal Ali]

Conservative management with drip and suck and serial examinations and x-rays

[Masoud]

B complete obstruction need to laparotomy
laparoscopy may be dangerous because previous multiple operations

[Aziza Elnaeema]

A

[Amal Adam]

A

[Admin]

correct answer
D contrast challenge via the NG tube

Several retrospective studies have demonstrated that a water-soluble contrast challenge is safe and effective in the non-operative management of children with adhesive small bowel obstructions and can be successful in reducing operative intervention. Abdominal exploration would be indicated if there was peritonitis, pneumoperitoneum or failed non-operative management. A contrast enema would not likely be helpful.