<![CDATA[Obstructive ileus is a surgical emergency caused by mechanical obstruction of the intestinal lumen and requires prompt diagnosis and management to prevent life-threatening complications. Colorectal malignancy is the leading cause of large bowel obstruction; therefore, a comprehensive diagnostic approach is essential to establish the underlying etiology and guide appropriate management. This case report aimed to describe the diagnostic process and management of obstructive ileus secondary to suspected colorectal malignancy in a 37-year-old male patient. The patient presented with colicky abdominal pain for three days before hospital admission, accompanied by progressive abdominal distension, nausea, vomiting, obstipation for five days, and inability to pass flatus. Physical examination revealed abdominal distension, diffuse abdominal tenderness, and hyperactive bowel sounds. Laboratory investigations demonstrated mild anemia, thrombocytosis, relative neutrophilia, mildly elevated blood urea and creatinine levels, and hypoalbuminemia. Three-view abdominal radiography revealed colonic dilatation with multiple air-fluid levels, consistent with large bowel obstruction. Based on the integration of clinical presentation, physical examination, laboratory findings, and radiological evaluation, the patient was diagnosed with obstructive ileus secondary to suspected colorectal malignancy. Initial management included intravenous fluid resuscitation, administration of ceftriaxone, metronidazole, analgesics, antiemetics, and supportive therapy before exploratory laparotomy was performed as the definitive treatment. This case highlights the importance of integrating clinical, laboratory, and radiological findings to facilitate early diagnosis and timely surgical decision-making, thereby preventing serious complications, including intestinal ischemia, bowel perforation, and sepsis.]]>
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