Last reviewed: February 2018
Last updated: November  2017



History and exam

Key diagnostic factors

  • failure to pass flatus or stool
  • abdominal pain
  • vomiting
  • abdominal distention
  • abdominal tenderness
  • absolute constipation
  • peritonitis
  • constipation
  • palpable abdominal mass
  • palpable rectal mass

Other diagnostic factors

  • nausea
  • fever
  • tachycardia
  • severe lethargy
  • hypotension
  • diarrhea
  • groin swelling

Risk factors

  • previous abdominal surgery
  • malrotation
  • Crohn disease
  • hernia
  • appendicitis
  • intestinal malignancy
  • intussusception
  • volvulus
  • intestinal atresia
  • foreign body ingestion

Diagnostic investigations

1st investigations to order

  • abdominal x-rays
  • CBC
  • BUN
  • electrolyte panel
  • abdominal CT scan
Full details

Investigations to consider

  • upper gastrointestinal (GI) x-ray with small bowel follow-through (SBFT)
  • laparotomy
  • laparoscopy
  • abdominal ultrasound
  • abdominal MRI
Full details

Treatment algorithm


Authors VIEW ALL

Consultant Colorectal Surgeon

Department of Coloproctology

St. Mark's Hospital




JTJ declares that he has no competing interests.

Honorary Clinical Lecturer

Department of Surgery and Cancer

Imperial College




GM declares that he has no competing interests.

Dr John T. Jenkins and Dr George Malietzis would like to gratefully acknowledge Dr Frances J. McNicol and Dr David J. Hackam, previous contributors to this monograph. FJM and DJH declare that they have no competing interests.

Peer reviewers VIEW ALL

Chief Academic Officer

Emeritus Chief of Staff (1997-2007)

Chairman Department of Colorectal Surgery

Professor of Surgery Ohio State University

Affiliate Professor Department of Surgery

Division of General Surgery

University of South Florida College of Medicine

Cleveland Clinic Florida



SDW declares that he has no competing interests.

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