From the Guidelines
Small bowel obstruction (SBO) is a serious condition where the small intestine is partially or completely blocked, and its causes include adhesions, hernias, tumors, and inflammatory bowel disease, with symptoms such as cramping abdominal pain, nausea, vomiting, abdominal distension, and constipation, as reported in the most recent study by 1.
Causes of Small Bowel Obstruction
The causes of SBO can be categorized into several main groups, including:
- Adhesions, which are the most common cause, accounting for approximately 55-75% of cases, as stated in 2
- Hernias, which account for a significant proportion of cases, as mentioned in 2
- Tumors, which can cause obstruction by compressing or invading the small intestine, as reported in 2
- Inflammatory bowel disease, which can cause narrowing or obstruction of the small intestine, as stated in 2 ### Symptoms of Small Bowel Obstruction The symptoms of SBO can vary depending on the severity and location of the obstruction, but common symptoms include:
- Cramping abdominal pain, which can be severe and debilitating, as reported in 1
- Nausea and vomiting, which can lead to dehydration and electrolyte imbalances, as stated in 1
- Abdominal distension, which can be caused by the accumulation of gas and fluid in the intestine, as mentioned in 1
- Constipation, which can be caused by the obstruction of the intestine, as reported in 1 ### Diagnosis of Small Bowel Obstruction The diagnosis of SBO typically involves a combination of physical examination, laboratory tests, and imaging studies, including:
- Abdominal X-rays, which can show dilated bowel loops and air-fluid levels, as stated in 3
- CT scans, which can provide detailed images of the obstruction site and potential complications, as reported in 3
- Physical examination, which can reveal signs of abdominal tenderness, guarding, and rebound tenderness, as mentioned in 1 ### Management of Small Bowel Obstruction The management of SBO depends on the severity and location of the obstruction, as well as the presence of any complications, and may include:
- Conservative management, which involves bowel rest, nasogastric tube decompression, and IV fluids, as reported in 1
- Surgical intervention, which may be necessary for complete obstructions, strangulation, or peritonitis, as stated in 4
- Prophylactic antibiotics, which may be administered to prevent infection, as mentioned in 4
From the Research
Causes of Small Bowel Obstruction (SBO)
- Adhesions are the most common cause of SBO in adults 5
- Other causes include internal hernia, incarcerated incisional hernia, and inflammatory bowel disease 6
- Malignant causes can also lead to SBO, but are often excluded from certain studies 6
- Intra-abdominal adhesions are responsible for approximately 75% of patients admitted with SBO 7
Symptoms of Small Bowel Obstruction (SBO)
- Abdominal distension, abnormal bowel sounds, and prior abdominal surgery are common findings 5
- Signs of strangulation include fever, hypotension, diffuse abdominal pain, and peritonitis 5
- Patients may also experience constipation, vomiting, and significant distension 5, 8
Diagnosis of Small Bowel Obstruction (SBO)
- Imaging is typically required for diagnosis, with computed tomography (CT) and ultrasound being reliable methods 5, 9
- Plain radiographs may be ordered, but cannot exclude the diagnosis 5
- Abdominal CT and serum urea and electrolytes are considered essential initial investigations by most consultants 9
Management of Small Bowel Obstruction (SBO)
- Intravenous fluid resuscitation, analgesia, and determining the need for operative vs. nonoperative therapy are important aspects of management 5
- Nasogastric tube is useful for patients with significant distension and vomiting 5
- Surgery is needed for strangulation and those that fail nonoperative therapy 5, 8
- Laparoscopic approach may be considered for patients with a single obstructing band, but conversion to an open procedure should be done if necessary 7, 6