When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Small bowel obstruction

Last reviewed: 21 Oct 2024
Last updated: 16 Aug 2024

Summary

Definition

History and exam

Key diagnostic factors

  • constipation/failure to pass flatus or stool
  • abdominal pain
  • vomiting
  • abdominal distention
  • abdominal tenderness
  • peritonitis
  • palpable abdominal mass
Full details

Other diagnostic factors

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

Risk factors

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

Diagnostic tests

1st tests to order

  • abdominal CT scan
  • CBC
  • BUN
  • electrolyte panel
Full details

Tests to consider

  • abdominal x-rays
  • water-soluble contrast study
  • laparotomy
  • laparoscopy
  • abdominal ultrasound
  • abdominal MRI
Full details

Treatment algorithm

ACUTE

complicated or strangulated SBO: surgical candidate

complicated or strangulated SBO: surgery contraindicated

simple SBO

Contributors

Authors

Adrian Maung, MD, MBA, FACS, FCCM

Associate Professor of Surgery

Division of General Surgery, Trauma and Surgical Critical Care, Department of Surgery

Yale School of Medicine

New Haven

CT

Disclosures

AM declares that he has no competing interests.

Acknowledgements

Dr Adrian Maung would like to gratefully acknowledge Dr John T. Jenkins, Dr Edward T. Pring, Dr George Malietzis, Dr Frances J. McNicol, and Dr David J. Hackam, previous contributors to this topic.

Disclosures

JTJ , ETP, GM, FJM, and DJH declare that they have no competing interests.

Peer reviewers

Steven D. Wexner, MD, FACS, FRCS, FRCS (Ed)

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

FL

Disclosures

SDW declares that he has no competing interests.

  • Small bowel obstruction images
  • Differentials

    • Ileus
    • Infectious gastroenteritis
    • Large bowel obstruction
    More Differentials
  • Guidelines

    • ACR-SPR practice parameter for the performance of a contrast small bowel examination
    • ACR appropriateness criteria: suspected small-bowel obstruction
    More Guidelines
  • Patient information

    Small bowel obstruction

    More Patient information
  • Videos

    Venepuncture and phlebotomy: animated demonstration

    Central venous catheter insertion: animated demonstration

    More videos
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer