What is the management for partial intestinal obstruction?

From the Guidelines

Management for partial obstruction involves a conservative approach initially, focusing on supportive care while monitoring for resolution or progression, as recommended by the most recent and highest quality study 1. The initial management should include supportive treatment with intravenous crystalloids, anti-emetics, and bowel rest, as stated in the study 1. Key components of this approach include:

• Keeping the patient nil by mouth (NPO) to reduce intestinal workload
• Inserting a nasogastric tube for decompression to relieve pressure and prevent vomiting
• Providing intravenous fluids, typically normal saline or lactated Ringer's solution, to maintain hydration and electrolyte balance
• Administering antiemetics such as ondansetron 4-8mg IV every 8 hours or metoclopramide 10mg IV every 6 hours to control nausea and vomiting
• Pain management with opioid analgesics like morphine 2-4mg IV every 4 hours may be necessary, but use cautiously as they can decrease intestinal motility Serial abdominal examinations and imaging (abdominal X-rays every 12-24 hours) are essential to monitor for improvement or worsening, as suggested by the study 1. It is also important to consider the patient's overall clinical status, prognosis, and expectations when making decisions about specific interventions, as recommended by the study 1. The goal of treatment should be to improve quality of life, and surgical intervention should be considered if symptoms worsen, signs of complete obstruction develop, or peritoneal signs appear, as stated in the study 1. Pharmacologic management can include opioids, antiemetics, and corticosteroids, alone or in combination, and somatostatin analogs (eg, octreotide) and/or anticholinergics may be considered in certain cases, as suggested by the study 1. Overall, the management of partial obstruction requires a multidisciplinary approach, taking into account the patient's individual needs and circumstances, as recommended by the study 1.

From the Research

Management for Partial Obstruction

• The management of partial small bowel obstruction (SBO) can be challenging due to its elusive diagnosis and less defined treatment plan 2.
• A protocol for the management of adhesive small bowel obstruction involves intravenous fluid resuscitation, bowel rest, nasogastric tube decompression, and abdominal examinations every 4 hours 3.
• The use of Gastroview (GV) via nasogastric tube can help diagnose and treat partial SBO, with patients passing GV to the colon within 5 hours of administration having a 90% rate of resolution of obstruction 3.
• The management of SBO includes determining the need for operative vs. nonoperative therapy, with surgery being needed for strangulation and those that fail nonoperative therapy 4.
• Nasogastric tube is useful for patients with significant distension and vomiting by removing contents proximal to the site of obstruction 4.
• Prokinetics such as metoclopramide can be used to treat delayed gastric emptying in critical illness, and a nasal formulation of metoclopramide has been approved for the treatment of symptoms of acute and recurrent diabetic gastroparesis 5, 6.

Treatment Approaches

• Operative and nonoperative approaches to treatment are successful and are based on the etiology and clinical status of the patient 2.
• A standardized protocol for the management of adhesive small bowel obstruction can help optimize diagnosis and management 3.
• The use of computed tomography and ultrasound are reliable diagnostic methods for SBO 4.
• Intravenous fluid resuscitation, analgesia, and determining need for operative vs. nonoperative therapy are important aspects of SBO management 4.

Diagnostic Tools

• Computed tomography scan of the abdomen and pelvis with intravenous contrast can help diagnose SBO 3.
• Abdominal plain films can be used to monitor the progression of SBO 3.
• The use of Gastroview (GV) via nasogastric tube can help diagnose and treat partial SBO 3.
• Ultrasound can be used to diagnose SBO, especially in patients with suspected strangulation or bowel compromise 4.