What are the treatment options for intestinal obstruction?

From the Guidelines

Treatment for bowel obstruction should begin with supportive care, including intravenous crystalloids, anti-emetics, and bowel rest, as soon as possible, to reduce morbidity and mortality. The initial management of bowel obstruction involves several key components, including:

• Intravenous fluids for hydration, with isotonic dextrose-saline crystalloid and balanced isotonic crystalloid replacement fluids containing supplemental potassium in an equivalent volume to the patient’s losses, as recommended by 1
• Bowel rest (nothing by mouth) to reduce the workload on the bowel and prevent further distension
• Nasogastric tube placement to decompress the stomach and intestines, which can be both diagnostically useful and therapeutically important to prevent aspiration pneumonia, as noted in 1
• Pain management with medications like morphine or hydromorphone, as needed, to control symptoms and improve quality of life
• Monitoring for complications like perforation, ischemia, or sepsis, which can have a significant impact on morbidity and mortality

For partial obstructions, conservative treatment might be sufficient, allowing the blockage to resolve on its own within 2-3 days, as suggested by 1. However, complete obstructions usually require surgical intervention to remove the blockage, which may involve resection of the affected bowel segment or lysis of adhesions. In cases where the obstruction is caused by fecal impaction, manual disimpaction or enemas might be used, as noted in the example answer. Antibiotics such as piperacillin-tazobactam or ceftriaxone plus metronidazole are administered if infection is present or suspected, to reduce the risk of complications and improve outcomes.

The underlying pathophysiology of bowel obstruction involves distension of the bowel proximal to the obstruction, leading to increased pressure, decreased blood flow, and potential tissue damage, which explains why prompt treatment is essential to prevent serious complications, as discussed in the example answer. The goal of treatment is to improve quality of life, reduce morbidity and mortality, and prevent long-term complications, as emphasized by 1, 1, and 1.

In terms of specific interventions, the use of water-soluble contrast administration has been shown to be a valid and safe treatment that correlates with a significant reduction in the need for surgery in patients with adhesive small bowel obstruction, as noted in 1. Additionally, self-expanding metallic stents can be used for palliation of obstructing left colon cancer, and may be preferred to colostomy due to similar mortality/morbidity rates but a shorter hospital stay, as discussed in 1.

Overall, the treatment of bowel obstruction requires a comprehensive approach that takes into account the severity and cause of the blockage, as well as the patient's overall health status and quality of life, as emphasized by 1, 1, 1, 1, and 1.

From the Research

Treatment Options for Bowel Obstruction

• The treatment for bowel obstruction can be either conservative or surgical, depending on the severity and cause of the obstruction 2, 3, 4, 5.
• Conservative treatment typically involves intravenous fluid resuscitation, analgesia, and nasogastric decompression to remove contents proximal to the site of obstruction 2, 4, 6.
• Surgical intervention is usually required for cases of strangulation, perforation, or failure of conservative treatment 2, 3, 4, 5.

Indications for Surgical Intervention

• Signs of strangulation, such as fever, hypotension, diffuse abdominal pain, and peritonitis, are indications for surgical intervention 2, 3, 4.
• Complete bowel obstruction, especially if complicated, is more likely to require surgical intervention 2, 3.
• Failure of conservative treatment, as evidenced by persistent symptoms or lack of improvement, may also necessitate surgical intervention 3, 5.

Conservative Treatment Success Rates

• The success rate of conservative treatment for bowel obstruction varies, ranging from 16% to 75% in children 6 and 64% in adults with partial obstruction 3.
• Patients with partial obstruction and no signs of strangulation are more likely to respond to conservative treatment 3.
• The length of hospital stay and time to first feeding are generally shorter for patients treated conservatively compared to those who undergo surgery 5, 6.

Risk Factors and Recurrence Rates

• Prior abdominal surgery is a significant risk factor for developing bowel obstruction 5.
• The frequency of recurrence is higher in patients treated conservatively compared to those who undergo surgery 5.
• The time to recurrence is shorter in patients treated conservatively, with a mean time of 153 days compared to 411 days for those treated operatively 5.