From the Guidelines
Treatment of small bowel obstruction (SBO) due to enteritis should primarily involve supportive care with bowel rest, intravenous fluid resuscitation, and nasogastric tube decompression for up to 72 hours, as this approach is effective in approximately 70-90% of patients with ASBO 1.
Initial Management
Initial management includes:
- Bowel rest with nothing by mouth (NPO) to reduce intestinal inflammation and allow the bowel to resume normal motility and function
- Intravenous fluid resuscitation to correct electrolyte imbalances and prevent dehydration with kidney injury
- Nasogastric tube decompression to relieve distension and vomiting
- Antibiotics if bacterial enteritis is suspected, with empiric therapy including ciprofloxacin and metronidazole, adjusted based on culture results
- Anti-inflammatory medications, such as corticosteroids, for non-infectious causes like inflammatory bowel disease
- Pain management with opioids, like morphine, as needed
Monitoring and Surgical Intervention
Close monitoring of vital signs, abdominal examination, and serial imaging is essential to assess for improvement or complications, such as perforation. Most cases resolve with conservative management within 24-72 hours, but persistent obstruction may require surgical intervention. Laparoscopic surgery may be considered for selected patients, but it is crucial to carefully select candidates and be aware of the potential risks, including bowel injury and delayed diagnosis of perforations 1.
Key Considerations
- The cornerstone of non-operative management is nil per os and decompression using a naso-gastric tube or long intestinal tube 1
- Non-operative management should further include fluid resuscitation, correction of electrolyte disturbances, nutritional support, and prevention of aspiration 1
- The optimal duration of non-operative treatment is subject to debate, but most authors consider a 72-h period as safe and appropriate 1
From the Research
Treatment of Small Bowel Obstruction (SBO) due to Enteritis
- The treatment of SBO due to enteritis is primarily focused on managing the underlying cause of the obstruction, which in this case is enteritis, an inflammation of the small intestine.
- According to 2, the management of SBO includes intravenous fluid resuscitation, analgesia, and determining the need for operative vs. nonoperative therapy.
- Nasogastric tube is useful for patients with significant distension and vomiting by removing contents proximal to the site of obstruction, as stated in 2.
- The use of computed tomography (CT) and ultrasound are reliable diagnostic methods for SBO, as mentioned in 2 and 3.
- Medical resuscitation includes intravenous hydration, correcting electrolyte abnormalities, intravenous antibiotics, nil per os, and nasoenteral suction, as outlined in 3.
- Abdominal CT with oral and intravenous gastrografin contrast is highly sensitive and specific in detecting and characterizing SBO, as stated in 3.
- Surgery is needed for strangulation and those that fail nonoperative therapy, as mentioned in 2 and 3.
- A protocol for administration of Gastrografin immediately in the emergency department can efficiently sort patients into those who will resolve their obstructions and those who will fail nonoperative management, as described in 4.
Specific Considerations for Enteritis
- Enteritis, being an inflammatory condition, may require specific treatment aimed at reducing inflammation and managing symptoms.
- However, the provided studies do not specifically address the treatment of SBO due to enteritis, focusing more on the general management of SBO.
- Therefore, the treatment approach would likely involve a combination of the general management strategies for SBO, as outlined above, along with specific treatments for enteritis, such as anti-inflammatory medications and supportive care.