What is the treatment for small bowel obstruction?

From the Guidelines

Treatment of Small Bowel Obstruction

Treatment of small bowel obstruction typically involves a multidisciplinary approach, with initial management focusing on fluid resuscitation and bowel rest 1.

• Initial Management: Supportive treatment must begin as soon as possible with intravenous crystalloids, anti-emetics, and bowel rest 1.
• Nasogastric Suction: Nasogastric suction can be diagnostically useful to analyze gastric contents and therapeutically important to prevent aspiration pneumonia and decompress the proximal bowel 1.
• Conservative Management: In cases of partial obstruction, a trial of conservative management with bowel rest, IV fluids, and anti-emetics such as ondansetron may be attempted for 24-48 hours 1.
• Surgical Intervention: Complete obstructions often require prompt surgical intervention 1.
• Water-Soluble Contrast Administration: Water-soluble contrast administration is a valid and safe treatment that correlates with a significant reduction in the need for surgery in patients with adhesive small bowel obstruction 1.
• Management of Complicated Cases: In case of complicated hernia, a prompt manual reduction has to be attempted, and emergency surgery is needed for unsuccessful reduction 1.

The management approach may vary depending on the underlying cause of the obstruction, such as adhesions, hernias, or malignancies 1. In general, the treatment principles for small bowel obstruction in a virgin abdomen are comparable to those for patients with a history of abdominal surgery 1.

From the FDA Drug Label

Metoclopramide Injection may be used to facilitate small bowel intubation in adults and pediatric patients in whom the tube does not pass the pylorus with conventional maneuvers The treatment for small bowel obstruction is not explicitly stated in the provided drug labels, but metoclopramide may be used to facilitate small bowel intubation in cases where the tube does not pass the pylorus with conventional maneuvers 2.

• Key points:
  • Metoclopramide may help with small bowel intubation.
  • The labels do not provide a direct treatment for small bowel obstruction.

From the Research

Treatment Overview

The treatment for small bowel obstruction typically involves a combination of non-surgical and surgical interventions.

• Non-surgical management includes intravenous fluid resuscitation, bowel rest, and nasogastric tube decompression 3, 4, 5.
• Patients with partial obstruction may benefit from oral therapy with laxatives, digestants, and defoaming agents, which can help reduce the frequency of subsequent surgical intervention and shorten hospital stays 6.

Surgical Intervention

Surgical intervention is often necessary for patients with complete obstruction, strangulation, or those who fail non-operative therapy 3, 4, 5, 7.

• The decision to operate is typically based on clinical and imaging findings, such as signs of strangulation, peritonitis, or bowel compromise 4, 5, 7.
• Surgical exploration and intervention can help prevent complications such as intestinal necrosis and perforation 7.

Diagnostic Imaging

Imaging modalities such as computed tomography (CT) and small bowel follow-through (SBFT) are widely used to confirm the diagnosis of small bowel obstruction and guide surgical management 4, 5, 7.

• CT scans can help identify signs of bowel compromise, such as ischemia or perforation, and guide the decision to operate 4, 5, 7.
• The use of contrast agents, such as Gastroview, can help diagnose and manage small bowel obstruction, particularly in patients with partial obstruction 5.

Management Protocols

Standardized protocols for the management of small bowel obstruction can help optimize diagnosis and treatment 5.

• These protocols typically involve a combination of clinical evaluation, imaging, and non-surgical and surgical interventions, tailored to the individual patient's needs 4, 5, 7.