24 Hours Of Progressive in Surgery — Case | General Surgery | SMLE Q#11918

SMLE Question #11918

Surgery General Surgery

Objective: OBJ-TRACH-EMERG-01

Last updated: February 2026
A 70-year-old multiparous woman with chronic constipation presents with 24 hours of progressive abdominal distension, colicky abdominal pain, and repeated bilious vomiting. She has had no flatus or stool for 18 hours. Examination shows a distended, tympanic abdomen with diffuse tenderness and high-pitched bowel sounds. There is a round, tender, irreducible right groin swelling located below and lateral to the pubic tubercle. Upright abdominal radiograph shows dilated small-bowel loops with multiple air-fluid levels. What is the most likely diagnosis?

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