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Home / Bowel obstruction and perforation
Surgical OSCE — complete topic guide

Bowel obstruction and perforation

Turn this presentation into an 11-minute OSCE performance: focused assessment, prioritized differential, targeted examination and investigations, immediate management, communication, disposition and safety-netting.

What you must demonstrate

  • Surgical history and focused examination
  • ABCDE approach
  • Analgesia, fluids and early consultation
  • Consent including risks, benefits and alternatives
  • Postoperative complication recognition
Do not miss: Peritonitis · Shock · Compartment syndrome · Tension pneumothorax · Ischemic limb · Postoperative sepsis

11-minute performance map

0:00–0:45

1. Opening and immediate safety

Introduce yourself, confirm identity, explain the task, obtain consent and identify instability before routine questioning.

0:45–4:30

2. Focused assessment

Clarify onset, progression, severity, associated features, discriminating positives/negatives and the most relevant background risks.

4:30–6:30

3. Targeted examination

Perform only the examination maneuvers needed to assess severity, confirm localization and discriminate the leading diagnoses.

6:30–7:30

4. Synthesize

Give a one-sentence summary, leading diagnosis and two to four prioritized alternatives including the dangerous diagnosis you cannot miss.

7:30–8:40

5. Investigations

Choose tests that answer a specific diagnostic or safety question; state urgent tests first.

8:40–10:15

6. Immediate management

Treat instability, begin syndrome-specific care, consult early when needed and define disposition.

10:15–11:00

7. Communication and safety net

Explain the plan, check understanding, address concerns and state exact deterioration/return criteria.

Focused history prompts

Define the presentation

  • Onset, chronology, triggers and progression.
  • Severity and effect on function.
  • Associated symptoms that support the leading diagnosis.
  • Relevant negatives that reduce dangerous alternatives.

Risk context

  • Relevant past medical/surgical/obstetric/psychiatric history.
  • Medications, allergies and adherence.
  • Family, social, substance, travel/exposure or safeguarding factors as applicable.
  • Patient ideas, concerns, expectations and goals.

Dangerous alternatives to prioritize

  1. Peritonitis
  2. Shock
  3. Compartment syndrome
  4. Tension pneumothorax
  5. Ischemic limb
  6. Postoperative sepsis

Targeted investigations

CBC, electrolytes/renal function, glucose, coagulation and type/screen when bleeding/operation is possible

Pregnancy testing when relevant

Targeted ultrasound, radiography or CT according to the surgical question

Cultures/lactate and source-control investigations in sepsis

Immediate management and disposition

  1. Keep unstable/high-risk patients monitored and resuscitate with IV access, analgesia and fluids/blood as indicated.
  2. Keep NPO when urgent surgery/procedure is possible.
  3. Start antibiotics when infection or contamination is suspected according to local protocol.
  4. Obtain early surgical consultation and define source control/operative versus nonoperative pathway.
High-yield closing sentence: “I would reassess after the initial intervention, escalate if there is deterioration, explain the plan in plain language, confirm understanding and give specific safety-net instructions.”

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