The lecture's indications for early surgery in SBO include rapidly progressing pain or distention, peritonitis, fever and leukocytosis, failure to resolve after 48 hours, obstructed external hernia, and suspected strangulation. Worsening abdominal pain is the only option on that list.

• Distention and air-fluid levels are present in almost every SBO. They confirm the diagnosis but do not by themselves mean surgery is needed.
• A midline scar points to adhesions, which are usually treated conservatively first.
• Air in the colon suggests a partial obstruction.
• The old bank's answer (D, air-fluid levels) is wrong.