24 Hours Of Worsening in Surgery — 46yo Man | General Surgery | SMLE Q#17224
SMLE Question #17224
Surgery
General Surgery
Objective: OBJ-TRACH-EMERG-01
Last updated: February 2026
A 46-year-old man presents with 24 hours of worsening abdominal pain, abdominal distension, and bilious vomiting. He underwent an open splenectomy 2 weeks ago. He has not passed flatus or stool for 18 hours. Examination shows marked distension and diffuse tenderness without guarding; bowel sounds are reduced. Abdominal X-ray shows multiple dilated small-bowel loops with air–fluid levels and no free air. What is the most appropriate initial management?
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