From the Guidelines
Bowel obstruction symptoms include abdominal pain, nausea, vomiting, constipation, and abdominal distension, with the severity and combination of symptoms depending on the location, cause, and completeness of the obstruction. The symptoms of bowel obstruction can vary, but they often include abdominal pain that is colic in onset due to an increase in motility to overcome occlusion, as noted in a narrative review for all physicians 1. This pain can be intense and untreatable with analgesics in cases of ischemia or perforation. Nausea and emesis are earlier and more represented in small bowel obstruction, while abdominal distension is a common finding in both small and large bowel obstructions.
Some key symptoms and signs to look out for include:
- Abdominal pain, which can be crampy and come in waves
- Nausea and vomiting, with vomiting that may become feculent in complete obstructions
- Constipation or inability to pass gas (obstipation)
- Changes in bowel sounds, initially becoming high-pitched and hyperactive before potentially becoming quiet in later stages
- Fever, tachycardia, and signs of dehydration as the condition progresses
- Abdominal distension, which can be sudden in onset for volvulus or progressive for colorectal cancer, with a positive likelihood ratio of 16.8 and negative likelihood ratio of 0.27, as reported in a study 1.
It's essential to evaluate vital signs, including cardiopulmonary examination, especially in elderly or unconscious patients, as severe bowel obstruction can cause hypovolemic shock and, in case of perforation, septic shock 1. Laboratory tests, such as a complete blood count, renal function, and electrolytes, can help diagnose intestinal ischemia and guide management strategies. A thorough clinical examination, including anamnesis and evaluation of vital signs, is crucial in diagnosing bowel obstruction and determining the best course of treatment.
From the Research
Symptoms of Bowel Obstruction
The symptoms of bowel obstruction can vary depending on the location and severity of the obstruction. Common symptoms include:
- Abdominal pain, which can be colicky in nature 2, 3
- Nausea and emesis (vomiting) 2, 3
- Abdominal distention (swelling) 2, 3
- Cessation of passage of flatus and stool 3
- Constipation-to-obstipation (inability to pass stool or gas) 2
- High-pitched bowel sounds 3
- Tympany to percussion (a drum-like sound when the abdomen is tapped) 3
Clinical Presentation
The clinical presentation of bowel obstruction can also include signs of dehydration and sepsis, such as:
- Restlessness and acute illness 2
- Tachycardia (rapid heart rate) 2
- Pyrexia (fever) 2
- Dry mucous membranes 2
- Hypotension/orthostasis (low blood pressure) 2
- Abdominal tenderness, guarding, and rebound tenderness 2
Laboratory and Imaging Findings
Laboratory evaluation may reveal:
- Leukocytosis (elevated white blood cell count) 2, 3
- Neutrophilia (elevated neutrophil count) 2
- Bandemia (elevated band count) 2
- Lactic acidosis (elevated lactic acid levels) 2, 3 Imaging studies, such as abdominal radiography or computed tomography, can confirm the diagnosis and assist in decision making for therapeutic planning 2, 3