12 Hours Of Sudden in Surgery — 75yo Man | General Surgery | SMLE Q#16822
SMLE Question #16822
Surgery
General Surgery
Objective: OBJ-TRACH-EMERG-01
Last updated: February 2026
A 75-year-old man presents with 12 hours of sudden, crampy lower abdominal pain, progressive abdominal distension, nausea, vomiting, and absolute constipation with no flatus. He has chronic constipation and no prior abdominal surgery. Examination shows a grossly distended, tympanic abdomen with generalized tenderness but no peritonitis; bowel sounds are high-pitched. Digital rectal examination reveals an empty rectum. An erect abdominal X-ray shows a massively dilated, U-shaped loop arising from the pelvis and pointing to the right upper quadrant. What is the most likely diagnosis?
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