What are the symptoms of intestinal obstruction?

From the Guidelines

Bowel obstruction symptoms typically include abdominal pain, bloating, nausea, vomiting, constipation, and inability to pass gas, and require prompt medical attention to prevent serious complications. The symptoms of bowel obstruction can vary depending on the location and severity of the blockage, but common symptoms include:

• Abdominal pain that is often crampy and comes in waves, worsening over time 1
• Nausea and vomiting, which may contain fecal material in complete obstructions 1
• Constipation and inability to pass gas 1
• Distended abdomen that is tender to touch, with high-pitched or absent bowel sounds 1
• Fever, rapid heart rate, and severe pain may indicate complications like bowel strangulation or perforation, requiring immediate medical attention 1 These symptoms occur because the intestinal blockage prevents normal passage of digestive contents, causing backup and distension of the bowel, and fluid and gas accumulate behind the obstruction, stretching the intestinal wall and stimulating pain receptors 1. It is essential to note that bowel obstruction is a significant cause of morbidity and mortality, accounting for nearly 30,000 deaths and more than $3 billion per year in direct medical costs, and approximately 15% of hospital admissions for acute abdominal pain in the USA 1. The etiology of bowel obstruction can be based on a mechanical intrinsic luminal obstruction or extrinsic compression, and adynamic ileus and colonic pseudo-obstruction are caused by a lack of enteric propulsion 1. In 90% of cases, small bowel obstruction is caused by adhesions, hernias, and neoplasms, while large bowel obstruction is provoked by cancer in about 60% of cases 1. Prompt evaluation and treatment are crucial to prevent serious complications, including tissue death, perforation, and life-threatening infection 1.

From the Research

Bowel Obstruction Symptoms

• The symptoms of bowel obstruction can vary, but common signs include prior abdominal surgery, history of constipation, abdominal distension, and abnormal bowel sounds 2.
• Signs of strangulation, a complication of bowel obstruction, include fever, hypotension, diffuse abdominal pain, and peritonitis 2, 3.
• In patients with malignant bowel obstruction, symptoms can improve with anti-inflammatory, anti-secretory, and prokinetic/anti-nausea combination medical therapy 4.
• Nausea, pain, and time to resumption of oral intake are important outcomes to measure in patients with malignant bowel obstruction 4.

Diagnosis and Management

• Diagnosis of bowel obstruction typically requires imaging, with computed tomography and ultrasound being reliable diagnostic methods 2, 3.
• Management of bowel obstruction includes intravenous fluid resuscitation, analgesia, and determining the need for operative vs. nonoperative therapy 2.
• Nasogastric tube is useful for patients with significant distension and vomiting by removing contents proximal to the site of obstruction 2.
• Surgery is needed for strangulation and those that fail nonoperative therapy, with surgical service evaluation and admission recommended 2.
• Parenteral nutrition can be considered in selected patients with malignant bowel obstruction who benefit from standard palliative treatment and are obliged to maintain a total bowel rest for weeks or months 5.

Medical Management

• Octreotide is effective in reducing gastrointestinal secretions and colic, and thereby reduces nausea and vomiting caused by malignant bowel obstruction 4, 6.
• Scopolamine butylbromide is inferior to octreotide in the doses used in the comparison study 6.
• Olanzapine or metoclopramide may be effective in reducing nausea and vomiting secondary to partial bowel obstructions, with additional studies needed to clarify benefits 6.
• The use of antiemetics such as metoclopramide and olanzapine may be effective, but more randomized trials are needed to clarify their effectiveness in malignant bowel obstruction 6.