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Updated: Dec 15 2021

Small Bowel Obstruction

  • Snapshot
    • A 45-year-old woman presents to the emergency room for abdominal pain, nausea, and nonbloody vomiting for the past day. She has not had any flatus during this time. She also endorses decreased appetite. She has a past surgical history of cesarean section. On physical exam, there is diffuse tenderness to palpation of her abdomen but no rebound tenderness or guarding. An abdominal radiograph shows dilated loops of small bowel, which is confirmed with a CT abdomen and pelvis. There are no masses identified. She is admitted to the inpatient floor and a nasogastric tube is placed.
  • Introduction
    • Overview
      • partial or complete blockage of the small intestines
  • Epidemiology
    • Incidence
      • common
    • Risk factors
      • prior abdominal surgeries (most common)
        • post-operative adhesions
      • masses/malignancy
      • hernias
      • inflammatory bowel disease
      • intussusception (in children)
  • Presentation
    • History
      • decreased appetite
      • lack of flatus
      • constipation
    • Symptoms
      • common symptoms
        • nausea and vomiting
        • abdominal pain
    • Physical exam
      • inspection
        • abdominal distention
      • motion
        • generalized tenderness to palpation
  • Imaging
    • Abdominal radiographs
      • indications
        • best initial test
      • findings
        • dilated loops of small bowel
        • free air may indicate need for immediate surgery
    • Computed tomography (CT) of abdomen and pelvis
      • indications
        • diagnosis of SBO
      • findings
        • dilated loops of small bowel
        • transition point
        • any masses present
  • Studies
    • Serum labs
      • lactic acid to monitor for bowel necrosis if suspected
    • Invasive studies
      • small bowel follow-through with gastrograffin
        • indication
          • patients who fail to improve clinically after 48 hours of nonoperative treatment
          • may rule out need for surgery
  • Differential
    • Appendicitis
      • distinguishing factor
        • imaging shows enlarged appendix with signs of inflammation instead of dilated loops of bowel with transition point
  • Treatment
    • Conservative and lifestyle
      • supportive care
        • modalities
          • intravenous fluids
    • Medical and pharmacologic
      • treat underlying condition
      • nasogastric decompression and bowel rest
        • indications
          • partial SBO
          • no signs concerning for bowel strangulation
    • Surgical and interventional
      • surgical intervention with correction of cause of SBO (i.e., lysis of adhesions)
        • indications
          • peritonitis
          • signs concerning for bowel strangulation
            • systemic signs (e.g., fever)
            • metabolic acidosis
            • continuous pain
  • Complications
    • Bowel necrosis
    • Peritonitis
    • Bowel perforation
  • Prognosis
    • Partial SBOs often self-resolve
    • Complete SBOs may also self-resolve but often require surgical intervention
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