PAEA Surgery End Of Rotation (EOR) Practice Exam

What type of patient should warrant a high clinical suspicion for small bowel carcinoma?

1. Any patient over 70 years old

2. Patients with prior abdominal surgery

3. Patients presenting with SBO without prior abdominal surgery or hernia

4. Diabetic patients

The correct answer is: Patients presenting with SBO without prior abdominal surgery or hernia

Small bowel carcinoma, while relatively rare compared to other gastrointestinal malignancies, should be considered in specific patient presentations. A patient presenting with small bowel obstruction (SBO) without a history of prior abdominal surgery or a hernia deserves a high index of suspicion for potential malignant causes, including small bowel cancer. In such cases, the absence of common risk factors, like previous surgical history or external hernias, suggests that the obstruction could stem from an intrinsic lesion within the bowel itself, which could be a tumor. Tumors in the small bowel can lead to obstruction, and when no obstruction-related history is present, it raises the clinical suspicion for malignancy. Certain demographics, such as older age or underlying conditions like diabetes, might provide some increased risk for various gastrointestinal pathologies, but they do not specifically elevate concern for small bowel carcinoma in the same way that an unexplained obstruction does. Furthermore, while prior abdominal surgery is a risk factor for adhesions and obstructions, it does not specifically signal the need to rule out cancer as the cause of SBO. Therefore, the specific scenario of SBO occurring without common predisposing factors is key in directing attention towards small bowel carcinoma.