A 52-year-old female presents with diffuse abdominal pain accompanied by distention and visible peristalsis. Auscultation reveals hyperactive bowel sounds. Percussion is tympanic throughout. Palpation reveals mild diffuse tenderness without masses. The most likely diagnosis is

• A. Intra-abdominal abscess
• B. Intestinal obstruction
• C. Paralytic ileus
• D. Cholecystitis

Answer: (A)

Distinguish obstructive patterns by how the bowel behaves and sounds. When a physical obstruction blocks the lumen, the bowel works harder to move contents past the blockage, producing loud, hyperactive sounds early on (often described as borborygmi) and crampy, intermittent pain. The abdomen becomes distended, and you may see visible peristalsis as the bowel tries to move the contents along. A tympanic, drum-like resonance from gas-filled loops is common. Tenderness is usually mild and diffuse unless complications arise.

This combination—diffuse distention, visible peristalsis, hyperactive bowel sounds, and tympanic percussion—fits intestinal obstruction well. In contrast, a productive intra-abdominal abscess typically causes localized, often feverish inflammation with a more localized tender area or mass and may have decreased bowel sounds due to adjacent ileus. Paralytic ileus presents with hypoactive or absent bowel sounds and more uniform distention without the characteristic visible peristalsis or colicky pain. Cholecystitis would present with right upper quadrant pain, Murphy sign, and systemic illness rather than diffuse distention and hyperactive sounds.

So the presentation most aligns with intestinal obstruction.