In this BoardsCast episode, we continue Tobias Chapter 92 - Small Intestine by confronting one of the most lethal instincts in GI surgery:

“Save as much bowel as you can.”

With linear foreign bodies, that instinct is the trap.

Because a linear foreign body isn’t a simple obstruction — it’s a tension-driven injury pattern that creates diffuse damage, especially along the mesenteric border where the blood supply enters the bowel. And the inside injury is often worse than what your eyes show you on the serosa.

This episode rebuilds the decision-making framework the boards want you to recognize instantly: preservation does not equal safety.

You’ll learn:

• Why linear foreign bodies are mechanically different than “normal” obstructions (anchor + tension + pleating)
• The classic anchor points: base of tongue (cats) and pylorus (dogs)
• The “accordion” mechanism — and why the string saws along the mesenteric border (the blood-supply side)
• The diagnostic pattern: teardrop/triangular gas + bunched bowel (not normal tubular gas)
• Why “it looks pink / it has peristalsis” is an unreliable viability test in linear FB cases
• The board trap: multiple enterotomies + bruised bowel → septic peritonitis at 48 hours (decision error, not suture error)
• The two non-negotiable rules: release the anchor first, resect doubt, and preserve certainty

This episode teaches you how to stop thinking “how do I save bowel?” and start thinking “what bowel will still be alive tomorrow?”

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