Summary
Definition
History and exam
Key diagnostic factors
- constipation/failure to pass flatus or stool
- risk factors
- intermittent abdominal pain
- vomiting
- abdominal distention
- abdominal tenderness
- abdominal mass
- palpable rectal mass
- peritonitis
Other diagnostic factors
- pyrexia
- nausea (with or without vomiting)
- tachycardia
- groin swelling
Risk factors
- previous abdominal surgery
- malrotation
- Crohn's disease
- hernia
- appendicitis
- intestinal malignancy
- intussusception
- volvulus
- intestinal atresia
- foreign-body ingestion
Diagnostic investigations
1st investigations to order
- computed tomography
- water-soluble contrast study
- arterial blood gases (including lactate)
- full blood count
- electrolytes
- C-reactive protein
- urea/creatinine ratio
- serum lipase or amylase
- glucose
- clotting, group and save, or cross-match
Investigations to consider
- urine or serum beta–human chorionic gonadotrophin (HCG)
- urinalysis
- ECG
- magnetic resonance imaging
Treatment algorithm
complete or complicated small bowel obstruction: surgery indicated
complete or complicated small bowel obstruction: surgery not indicated
incomplete small bowel obstruction or complete without complications
Contributors
Expert advisers
John Abercrombie, FRCS
General and Colorectal Surgeon
Queen’s Medical Centre
Nottingham
UK
Biography
JA is Clinical Lead for General Surgery, Getting It Right First Time.
Disclosures
JA is trustee and council member of the Royal College of Surgeons of England.
Neena Randhawa, BSc (Hon), MSc, MBChB, FRCS
Consultant Colorectal Surgeon
Royal Victoria Infirmary
Newcastle-upon-Tyne
UK
Disclosures
NR declares she has no competing interests.
Acknowledgements
BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work is retained in parts of the content:
John T. Jenkins MD
Consultant Colorectal Surgeon
Department of Coloproctology
St. Mark's Hospital
London
UK
Disclosures: JTJ declares that he has no competing interests.
Edward T. Pring BSc(Hons), MBChB, MRCS
Surgical Registrar and Clinical Research Fellow
St. Mark's Hospital
London
UK
Disclosures: ETP declares that he has no competing interests.
George Malietzis
MBBS, MSc, MRCS
Honorary Clinical Lecturer
Department of Surgery and Cancer
Imperial College London
UK
Disclosures: GM declares that he has no competing interests.
Peer reviewers
Malcolm McFall, FRCS
Consultant Colorectal Surgeon
Western Sussex Hospitals NHS Foundation Trust
Chichester
West Sussex
UK
Disclosures
References
Key articles
Ten Broek RPG, Krielen P, Di Saverio S, et al. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the World Society Of Emergency Surgery ASBO working group. World J Emerg Surg. 2018 Jun 19;13:24.Full text Abstract
Ceresoli M, Coccolini F, Catena F, et al. Water-soluble contrast agent in adhesive small bowel obstruction: a systematic review and meta-analysis of diagnostic and therapeutic value. Am J Surg. 2016 Jun;211(6):1114-25. Abstract
Jackson P, Vigiola Cruz M. Intestinal obstruction: evaluation and management. Am Fam Physician. 2018 Sep 15;98(6):362-7. Abstract
Eugene N, Oliver CM, Bassett MG, et al. Development and internal validation of a novel risk adjustment model for adult patients undergoing emergency laparotomy surgery: the National Emergency Laparotomy Audit risk model. Br J Anaesth. 2018 Oct;121(4):739-748.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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