S4505 Unmasking the Unknown: A Case Series of Bowel Obstruction in the Virgin Abdomen and Its Surgical Imperatives

Introduction: Bowel obstruction (BO) in patients with no prior abdominal surgery—termed obstruction in the “virgin abdomen” (VA)—remains a diagnostic and therapeutic dilemma. Though surgical exploration is often reserved for recurrent or post-operative cases, the etiology of BO-VA is frequently underreported, with potentially serious consequences if left untreated. Case Description: This retrospective case series reviews 25 patients presenting with BO-VA at a tertiary care center over 2 years. All patients underwent contrast-enhanced computed tomography (CECT), with surgical management tailored based on clinical and imaging findings. Etiologies, intraoperative findings, histopathology, and postoperative outcomes were documented. Tuberculosis was the most common cause (24%), followed by malignancy, internal hernias, and congenital bands. Preoperative diagnosis was achieved in only 56% of cases; the rest were clarified intraoperatively. Notably, 6 patients with tubercular strictures and masses had features mimicking malignancy, highlighting the diagnostic ambiguity. All patients underwent laparotomy; none had major postoperative complications, emphasizing the safety and diagnostic value of early surgical intervention. Discussion: This study underscores the need to consider early operative exploration in BO-VA to prevent delayed diagnosis and adverse outcomes.