Small bowel obstruction
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
- 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 CT scan
- CBC
- BUN
- electrolyte panel
Investigations to consider
- abdominal x-rays
- water-soluble contrast study
- laparotomy
- laparoscopy
- abdominal ultrasound
- abdominal MRI
Treatment algorithm
complete or complicated or strangulated SBO: surgical candidate
complete or complicated or strangulated SBO: surgery contraindicated
partial SBO
Contributors
Authors
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.
Acknowledgements
Dr John T. Jenkins, Dr Edward T. Pring, and Dr George Malietzis would like to gratefully acknowledge Dr Frances J. McNicol and Dr David J. Hackam, previous contributors to this topic.
Disclosures
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.
Differentials
- Ileus
- Infectious gastroenteritis
- Large bowel obstruction
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