Question:medium

Which clinical feature best differentiates mechanical small intestinal obstruction from paralytic ileus?

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Bowel peristalsing against a block = cramps; paralysed bowel is silent.
Updated On: Jun 25, 2026
  • Colicky pain
  • Tachycardia
  • Abdominal distension
  • Vomiting
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The Correct Option is A

Solution and Explanation

The trick here is to pick the sign that is present in one entity but absent in the other, rather than a sign shared by both.

Think mechanistically. In mechanical obstruction the gut is healthy and keeps trying to push contents past a physical barrier, producing waves of contraction. Clinically this gives $colicky$ pain that comes and goes with each peristaltic wave, accompanied by loud, high-pitched, tinkling bowel sounds.

In paralytic ileus the smooth muscle itself has stopped working (post-operative, electrolyte disturbance, peritonitis). With no peristalsis there is no cramping - the abdomen distends quietly and bowel sounds are absent.

Testing each option:
$\bullet$ Abdominal distension to both.
$\bullet$ Vomiting to both.
$\bullet$ Tachycardia to both (fluid loss / sepsis).
$\bullet$ Colicky pain to only mechanical obstruction, because it requires active peristalsis.

\[\boxed{\text{Colicky pain is the differentiating feature}}\]
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