What are the symptoms of Small Intestine Obstruction?

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Symptoms of Small Intestinal Obstruction

The typical presentation of small intestinal obstruction includes intermittent crampy central abdominal pain, abdominal distension, nausea, and vomiting. 1

Cardinal Symptoms

  • Abdominal pain - Typically colicky and intermittent in nature, often centrally located 1, 2
  • Nausea and vomiting - More prominent with higher obstructions, may be feculent with lower obstructions 1, 2
  • Abdominal distension - Progressive swelling of the abdomen as gas and fluid accumulate 1, 3
  • Constipation/obstipation - Decreased or absent passage of stool and flatus, especially in complete obstruction 2

Physical Examination Findings

  • Abdominal distension with tympany to percussion 2
  • Abnormal bowel sounds - either high-pitched, tinkling sounds or absent sounds depending on the stage 1
  • Tenderness on palpation - may be diffuse or localized 1
  • Visible peristaltic waves in thin patients with high-grade obstruction 1

Warning Signs of Complications

  • Signs of peritonitis - Localized severe abdominal tenderness, rebound tenderness, and guarding suggest possible strangulation or perforation 1, 3
  • High fever - Temperature >38.5°C may indicate bowel ischemia or perforation 3
  • Severe leukocytosis - Elevated white blood cell count >10,000/mm³ may suggest strangulation 1
  • Metabolic acidosis - Indicates possible bowel ischemia 3
  • Elevated lactate levels - Suggests bowel ischemia requiring emergency intervention 1

Subacute Presentations

  • Intermittent symptoms in partial obstruction 1
  • Watery diarrhea may be present in incomplete obstruction (can be mistaken for gastroenteritis) 1
  • Stools might still be present in early presentation or high obstruction 1
  • Elderly patients may present with less prominent pain symptoms 1

Associated Symptoms from Complications

  • Small intestinal bacterial overgrowth (SIBO) - Can develop with prolonged obstruction, causing malabsorption symptoms 1
  • Steatorrhea - May occur with bacterial overgrowth in chronic partial obstruction 1
  • Malnutrition signs - Weight loss, muscle wasting in chronic cases 1
  • Dehydration - Dry mucous membranes, poor skin turgor, tachycardia 1

Laboratory Findings

  • Electrolyte disturbances - particularly hypokalemia 1
  • Elevated BUN/creatinine from dehydration 1
  • Elevated CRP (>75) and WBC (>10,000/mm³) may suggest peritonitis, though sensitivity and specificity are relatively low 1

Special Considerations

  • In patients with a history of cancer treatment, symptoms may be related to adhesions, radiation-induced fibrosis, or recurrent cancer 1
  • Subacute obstruction may be precipitated by excessive dietary fiber in patients with strictures 1
  • Opioid medications can worsen or precipitate obstruction symptoms, especially in sensitive patients 1

Early recognition of these symptoms is critical as mortality can be as high as 25% when bowel ischemia is present, making prompt diagnosis and management essential. 1

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Research

Intestinal Obstruction: Evaluation and Management.

American family physician, 2018

3
Research

Mechanical obstruction of the small bowel and colon.

The Medical clinics of North America, 2008

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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