رجل عمره ٦٦ سنة أجرى عملية استئصال قولون قبل سنتين، وصل بمغص متقطع في البطن من يوم، وقيء أخضر متكرر، ولم يُخرج غازات أو براز من ٢٤ ساعة. البطن منتفخ وأصوات الأمعاء عالية النبرة. الضغط ١٠٨/٦٨، النبض ١١٢، الحرارة ٣٧٫٦. ما الحالة المتوقعة؟

A 66-year-old man who had a colectomy two years ago presents with a day of colicky abdominal pain, repeated green vomiting and no flatus or stool for 24 hours. The abdomen is distended with high-pitched bowel sounds. BP 108/68, HR 112, T 37.6 °C. What is the likely condition?

1. Small bowel obstruction from adhesions after his previous surgery
2. Irritable bowel syndrome with bloating and gas
3. Chronic gastric ulcer with bile reflux into the stomach
4. Viral gastroenteritis with mild dehydration

Answer: A) Small bowel obstruction from adhesions after his previous surgery. Colicky pain, bilious vomiting, no flatus or stool, distension and high-pitched sounds after prior abdominal surgery indicate adhesive small bowel obstruction. Manage with NPO, NG decompression and IV fluids.