Ans. C. Recurrent small bowel obstruction. (Ref LB 25th pg. 1198)Rx of acute intestinal obstruction# GI drainage# Fluid and electrolyte replacement# Relief of obstruction# Surgical Rx is necessary for most cases of intestinal obstruction but should be delayed until resuscitation is complete, provided there is no sign of strangulation or evidence of closed-loop obstruction.Indications for early surgical intervention# Obstructed or strangulated external hernia# Internal intestinal strangulation# Acute obstructionRX OF RECURRENT INTESTINAL OBSTRUCTION DUE TO ADHESIONSSeveral procedures may be considered in the presence of recurrent obstruction, including:# Repeat adhesiolysis (enterolysis) alone;# Noble's plication operation;# Charles Phillipss transmesenteric plication;# intestinal intubation.Their relative efficacy remains unclear.In Noble's intestinal plication all involved intestine is freed. Adjacent coils (average length 15-20 cm) are sutured with serosal sutures to form gentle curves. If only a proportion of the small bowel is plicated, the mesentery must be united to prevent internal hernias. This procedure is time-consuming, and associated with a high morbidity and recurrent symptoms.In the Charles-Phillips operation. following adhesiolysis, the bowel is placed in an orderly fashion and three long synthetic sutures are passed through the mesentery of the plicated bowel, each doubled hack upon itself and tied loosely. The stitch should pass a few centimetres from the bowel wall and not be adjacent to it. The resultant bowel should look like a packet of sausages. Results from this procedure are relatively good.Intraluminal tube insertion (Baker), via a Witzel jejunostomv or gastrostomy, may facilitate the formation of gentle curves. Most tubes have an inflatable balloon near the tip to facilitate placement within the caecum. This procedure is associated with a long postoperative ileus, and reports of outcome are conflicting.RX OF VOLVULUS:# May involve the small intestine, Caecum, or sigmoid colon; neonatal nidgut volvulus secondary to midgut malrotation is life-threatening.# The commonest spontaneous type in adult is sigmoid volvulus.# Sigmoid volvulus can be relieved by decompression per anum# Surgery is required to prevent or relieve ischemia.Rx of MECONIUM ILEUS# Uncomplicated meconium ileus may respond to Rx with hyperosmolar gastrografin enema; this draws fluid into the gut lumen and also has detergent properties, which help to liquefy the meconium.# Meconium ileus complicated by intestinal perforation, volvulus, or atresia, or unresponsive to enemas, demands surgery.# Various surgical procedures are used including intestinal resection and temporary stoma formation, resection and primary anastomosis, and, in uncomplicated cases, enterostomy and irrigation of the bowel.# The Bishop-Koop operation with its irrigating stoma is now only rarely used.Rx of INTESTINAL ATRESIA# In most cases of jejunal or ileal atresia, the distal end of the dilated proximal small bowel is resected and primary end- to-end anastomosis is possible.# Ocassionally, a temporary stoma is required before definitive repair.