From the Research
Introduction to Small Bowel Obstruction
Small bowel obstruction (SBO) is a condition where the small intestine is partially or completely blocked, leading to fluid and gas accumulation, which can progress to mucosal ischemia, necrosis, and perforation if left untreated 1. The pathways for SBO can be complex and involve various etiologies.
Etiologies of Small Bowel Obstruction
The most common cause of SBO in adults is adhesions, which can occur after abdominal surgery 1. However, other etiologies such as malignancy, stool impaction, and inflammatory bowel disease can also cause SBO 2. Additionally, rare causes of SBO, such as internal hernias, kinking of the bowel, and ingestion of foreign bodies, can also occur 3, 4, 5.
Classification of Small Bowel Obstruction
SBO can be classified as complete or partial, and complicated or simple 1. Complete complicated SBO is more likely to require surgical intervention. The classification of SBO is crucial in determining the management and treatment of the condition.
Diagnosis of Small Bowel Obstruction
Diagnosis of SBO typically requires imaging, such as computed tomography (CT) or ultrasound, as plain radiographs may not be sufficient to exclude the diagnosis 1, 2. A physical examination and history can also provide valuable information, including prior abdominal surgery, history of constipation, abdominal distension, and abnormal bowel sounds 1.
Management of Small Bowel Obstruction
Management of SBO includes:
- Intravenous fluid resuscitation
- Analgesia
- Determining the need for operative vs. nonoperative therapy
- Nasogastric tube placement for patients with significant distension and vomiting
- Surgical intervention for strangulation, failed nonoperative therapy, or complicated SBO 1, 2
Treatment Options
Treatment options for SBO depend on the etiology and classification of the condition. Surgical intervention may be necessary for:
- Strangulation
- Complicated SBO
- Failed nonoperative therapy
- Rare causes of SBO, such as internal hernias or ingestion of foreign bodies 3, 4, 5 Nonoperative therapy, such as bowel rest and fluid resuscitation, may be sufficient for simple, partial SBO.
Differentials and Caveats
It is essential to consider a broad differential diagnosis for SBO, especially in patients with no history of abdominal surgery 5. Early surgical intervention may be necessary to prevent bowel ischemia and subsequent small bowel resection in patients presenting with concerning clinical and image findings 4.