Which symptom would most likely indicate bowel obstruction rather than mesenteric infarct?

Hyperactive, tinkling bowel sounds are indicative of a bowel obstruction. In cases of bowel obstruction, the area of the intestine proximal to the obstruction often becomes distended due to trapped gas and fluid, leading to increased peristalsis as the body attempts to push the contents past the obstruction. This results in high-pitched, hyperactive bowel sounds that can often be described as tinkling.

In contrast, mesenteric infarct is characterized by a decrease in blood supply to the bowel, which can lead to ischemia and necrosis. Initially, bowel sounds may be present, but as the condition progresses and the bowel becomes less functional, bowel sounds tend to diminish, leading to hypoactive sounds or even an absence of sounds. Other symptoms associated with mesenteric infarct include severe abdominal pain, fever, and elevated white blood cell count, indicating an inflammatory process. Thus, hyperactive, tinkling bowel sounds serve as a more definitive sign of bowel obstruction rather than mesenteric infarct, which typically presents differently.