From the Guidelines
Generally, a small bowel series is not necessary after a patient stops vomiting from a small bowel obstruction (SBO). Once vomiting has resolved, clinical improvement and return of bowel function are typically monitored through physical examination, passage of flatus or stool, and tolerance of oral intake. A small bowel series is more commonly used for initial diagnosis of SBO rather than follow-up after symptom resolution. However, if there are concerns about recurrence or incomplete resolution, other imaging modalities like CT scan or abdominal X-rays may be considered, as suggested by the World Journal of Emergency Surgery 1. These can help confirm the resolution of the obstruction and rule out any residual issues. The decision to perform additional imaging should be based on the patient's overall clinical picture, including physical exam findings, ability to tolerate oral intake, and presence of any persistent symptoms. If the patient is clinically improving with conservative management, further imaging is often unnecessary, as indicated by the Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO) 1. The rationale behind this approach is that once bowel function returns and vomiting stops, it generally indicates that the obstruction has resolved. Unnecessary imaging exposes the patient to radiation and potential contrast-related risks without providing significant additional clinical benefit in most cases. Key considerations in managing SBO include the use of non-operative management, such as bowel decompression, water-soluble contrast agents, and fluid resuscitation, as well as the role of surgical management in cases where non-operative management is not effective or appropriate, as discussed in the Journal of the American College of Radiology 1. In terms of specific imaging modalities, computed tomography (CT) is often the primary diagnostic tool of choice in patients with SBO, due to its ability to provide information related to the underlying cause of SBO and predict the need for emergency surgery, as noted in the World Journal of Emergency Surgery 1. Ultimately, the management of SBO should be individualized based on the patient's clinical presentation, medical history, and response to initial treatment, with a focus on minimizing morbidity, mortality, and improving quality of life.
From the Research
Diagnosis and Management of Small Bowel Obstruction
- The diagnosis of small bowel obstruction (SBO) typically requires imaging, with computed tomography (CT) and ultrasound being reliable diagnostic methods 2, 3.
- The management of SBO includes intravenous fluid resuscitation, analgesia, and determining the need for operative vs. nonoperative therapy 2, 4.
- A nasogastric tube is useful for patients with significant distension and vomiting by removing contents proximal to the site of obstruction 2, 4.
Role of Imaging in SBO
- CT and magnetic resonance imaging (MRI) are accurate in diagnosing SBO, with positive likelihood ratios of 3.6 and 6.77, respectively 3.
- Ultrasound has been shown to be superior to other imaging modalities, with a positive likelihood ratio of 14.1 and a negative likelihood ratio of 0.13 for formal scans 3.
- A contrast agent swallow, such as Gastrografin, can be used to help determine the need for surgery in patients with SBO, with a specificity of 96% and a sensitivity of 100% 5.
Necessity of Small Bowel Series after Vomiting Stops
- There is no direct evidence to suggest that a small bowel series is necessary after a patient stops vomiting from a small bowel obstruction 2, 6, 3, 4, 5.
- The decision to perform further imaging or testing should be based on the individual patient's clinical presentation and response to initial treatment 2, 3, 5.