A 68-year-old male musician presents to the emergency department with a sudden onset of colicky abdominal pain and massive vomiting of 4-hour duration. Examination shows an elevated WBC of 13,200 with a HCT of 45%. Electrolytes and blood urea nitrogen (BUN) are normal. An erect film of the abdomen reveals dilatation of the stomach with distended loops of bowel. What is his clinical diagnosis?: (A) Complete proximal intestinal obstruction, (B) Incomplete proximal intestinal obstruction, (C) Complete ileal obstruction, (D) Incomplete ileal obstruction
Answer is A. Mechanical obstruction implies a barrier that impedes progress of intestinal contents. Complete mid or distal small-bowel obstruction presents with colicky abdominal pain, more marked abdominal distention but with vomiting that is less frequent and occurs at a later stage than that of proximal jejunal obstruction.