From the Guidelines
Treatment for bowel obstruction typically involves hospitalization for supportive care while addressing the underlying cause, with initial management including bowel rest, intravenous fluids, and nasogastric tube placement, as recommended by the most recent study 1. The goal of treatment is to relieve the obstruction, manage symptoms, and prevent complications.
- Initial management includes:
- Bowel rest (nothing by mouth)
- Intravenous fluids to correct dehydration and electrolyte imbalances
- Nasogastric tube placement to decompress the stomach and intestines
- Pain management with medications like morphine or hydromorphone
- For partial obstructions, conservative management may be sufficient, allowing the obstruction to resolve over 24-72 hours, as suggested by 1.
- However, complete obstructions usually require surgical intervention to remove the blockage, which might involve resection of the affected bowel segment, lysis of adhesions, or removal of foreign bodies or tumors.
- In some cases, less invasive approaches like colonoscopic decompression for sigmoid volvulus or water-soluble contrast agents (like Gastrografin) may help resolve certain types of obstructions, as mentioned in 1. The specific treatment approach depends on the cause, location, and severity of the obstruction, as well as the patient's overall health status, and should be made in a multidisciplinary setting, including oncologists, surgeons, and endoscopists, as recommended by 1. Prompt treatment is essential as untreated bowel obstructions can lead to serious complications including bowel perforation, peritonitis, and sepsis.
- The decision about specific interventions should take into account the characteristics of the obstruction, patient’s expectations, prognosis, expected subsequent therapies, and functional status, as suggested by 1.
From the Research
Treatment for Bowel Obstruction
The treatment for bowel obstruction typically involves a combination of non-operative and operative management.
- Non-operative management includes:
- Intravenous fluid resuscitation to prevent dehydration and electrolyte imbalances 2
- Analgesia to manage pain
- Nasogastric tube decompression to remove contents proximal to the site of obstruction and relieve vomiting 2, 3
- Administration of water-soluble contrast media, such as Gastrografin, to predict the success of conservative treatment and potentially reduce hospital stay 4, 5, 3, 6
- Operative management is typically reserved for cases of strangulation, perforation, or failure of non-operative management 2, 3
- The use of water-soluble contrast media has been shown to be effective in predicting the success of non-operative management and reducing hospital stay 4, 5, 6
- Some studies have suggested that treatment without nasogastric tube decompression may be effective in selected patients, but further investigation is needed to determine the optimal selection criteria 6
Diagnostic Evaluation
- Diagnosis of bowel obstruction typically involves a combination of clinical evaluation, laboratory tests, and imaging studies 2
- Imaging studies, such as computed tomography (CT) and ultrasound, are reliable diagnostic methods for bowel obstruction 2
- Water-soluble contrast media can be used to predict the success of non-operative management and reduce hospital stay 4, 5, 3, 6
Management Protocols
- Management protocols for bowel obstruction should be evidence-based and take into account the individual patient's needs and circumstances 2, 3
- Protocols should include clear guidelines for non-operative and operative management, as well as criteria for selecting patients for treatment without nasogastric tube decompression 3, 6
- Multidisciplinary communication and collaboration are essential for effective management of bowel obstruction 3