Last reviewed: 25 Aug 2021
Last updated: 16 Sep 2021

Summary

Definition

History and exam

Key diagnostic factors

  • constipation/failure to pass flatus or stool
  • risk factors
  • intermittent abdominal pain
  • vomiting
  • abdominal distention
  • abdominal tenderness
  • abdominal mass
  • palpable rectal mass
  • peritonitis

Other diagnostic factors

  • pyrexia
  • nausea (with or without vomiting)
  • tachycardia
  • groin swelling

Risk factors

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

Diagnostic investigations

1st investigations to order

  • computed tomography
  • water-soluble contrast study
  • arterial blood gases (including lactate)
  • full blood count
  • electrolytes
  • C-reactive protein
  • urea/creatinine ratio
  • serum lipase or amylase
  • glucose
  • clotting, group and save, or cross-match

Investigations to consider

  • urine or serum beta–human chorionic gonadotrophin (HCG)
  • urinalysis
  • ECG
  • magnetic resonance imaging

Treatment algorithm

Contributors

Expert advisers

John Abercrombie, FRCS

General and Colorectal Surgeon

Queen’s Medical Centre

Nottingham

UK

Biography

JA is Clinical Lead for General Surgery, Getting It Right First Time.

Disclosures

JA is trustee and council member of the Royal College of Surgeons of England.

Neena Randhawa, BSc (Hon), MSc, MBChB, FRCS

Consultant Colorectal Surgeon

Royal Victoria Infirmary

Newcastle-upon-Tyne

UK

Disclosures

NR declares she has no competing interests.

Acknowledgements

BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work is retained in parts of the content:

John T. Jenkins MD

Consultant Colorectal Surgeon

Department of Coloproctology

St. Mark's Hospital

London

UK

Disclosures: JTJ declares that he has no competing interests.

Edward T. Pring BSc(Hons), MBChB, MRCS

Surgical Registrar and Clinical Research Fellow

St. Mark's Hospital

London

UK

Disclosures: ETP declares that he has no competing interests.

George Malietzis

MBBS, MSc, MRCS

Honorary Clinical Lecturer

Department of Surgery and Cancer

Imperial College London

UK

Disclosures: GM declares that he has no competing interests.

Peer reviewers

Malcolm McFall, FRCS

Consultant Colorectal Surgeon

Western Sussex Hospitals NHS Foundation Trust

Chichester

West Sussex

UK

Disclosures

Editors

Emma Quigley,

Section Editor, BMJ Best Practice

Disclosures

EQ declares that she has no competing interests.

Tannaz Aliabadi-Oglesby,

Lead Section Editor, BMJ Best Practice

Disclosures

TAO declares that she has no competing interests.

Anna Ellis,

Head of Editorial, BMJ Best Practice

Disclosures

AE declares that she has no competing interests.

Julie Costello,

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

Adam Mitchell,

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

Sue Mayor,

Lead Section Editor, BMJ Best Practice

Disclosures

SM works as a freelance medical journalist and editor, video editorial director and presenter, and communications trainer. In this capacity, she has been paid, and continues to be paid, by a wide range of organisations for providing these skills on a professional basis. These include: NHS organisations, including NICE, NHS Choices, NHS Kidney Care, and others; publishers and medical education companies, including the BMJ Group, the Lancet group, Medscape, and others; professional organisations, including the British Thoracic Oncology Group, the European Society for Medical Oncology, NCEPOD, and others; charities and patients’ organisations, including the Roy Castle Lung Cancer Foundation and others; pharmaceutical companies, including Bayer, Boehringer Ingelheim, Novartis, and others; and communications agencies, including Publicis, Red Healthcare, and others. She has no stock options or shares in any pharmaceutical or healthcare companies; however, she invests in a personal pension, which may invest in these types of companies. She is managing director of Susan Mayor Limited, the company name under which she provides medical writing and communications services.

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