From the Guidelines
Diarrhea is uncommon in patients with small bowel obstruction, typically occurring in cases of incomplete or partial obstruction, as seen in patients with watery diarrhea, which can be present in about a subset of patients. The presence of diarrhea in small bowel obstruction can be misleading, as it may be mistaken for gastroenteritis, especially in patients with incomplete obstruction 1. When evaluating a patient with suspected small bowel obstruction, clinicians should consider the possibility of partial obstruction, which can present with watery diarrhea, as noted in the Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO) 1.
Some key points to consider in the evaluation of small bowel obstruction include:
- The classic presentation of small bowel obstruction typically includes abdominal pain, nausea, vomiting, abdominal distension, and constipation, rather than diarrhea
- The presence of watery diarrhea can indicate a partial rather than complete obstruction, where liquid stool can still pass around the blockage
- The evaluation of ASBO by history taking and physical examination has a low sensitivity for detecting bowel strangulation and ischemia, highlighting the importance of careful assessment and consideration of other diagnostic possibilities 1
- Patients with incomplete obstruction or high small bowel obstruction may be more likely to present with diarrhea, which can sometimes be referred to as "paradoxical diarrhea"
In clinical practice, the presence of diarrhea in a patient with suspected small bowel obstruction should prompt careful evaluation and consideration of other diagnoses, including partial obstruction, inflammatory conditions, or infectious processes, as noted in the guidelines for ASBO management 1.
From the Research
Frequency of Diarrhea in Small Bowel Obstruction
- The frequency of diarrhea in patients with small bowel obstruction is not explicitly stated in most of the studies reviewed 2, 3, 4, 5.
- However, one study mentions that the classical clinical tetrad of small bowel obstruction includes abdominal pain, nausea and emesis, abdominal distention, and constipation-to-obstipation, suggesting that constipation is a more common symptom than diarrhea 3.
- Another study discusses diarrhea due to small bowel diseases, but it does not specifically address the frequency of diarrhea in small bowel obstruction 6.
- It is worth noting that small bowel obstruction is typically characterized by symptoms such as abdominal pain, nausea, vomiting, and constipation, rather than diarrhea 3, 4, 5.
Related Symptoms and Conditions
- Small bowel obstruction can cause a range of symptoms, including abdominal pain, nausea, vomiting, and constipation 3, 4, 5.
- Diarrhea can be a symptom of small bowel diseases, such as coeliac disease and environmental enteropathy 6.
- However, in the context of small bowel obstruction, diarrhea is not typically listed as a common symptom 2, 3, 4, 5.