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
complete or complicated small bowel obstruction: surgery indicated
complete or complicated small bowel obstruction: surgery not indicated
incomplete small bowel obstruction or complete without complications
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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