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Overview of management of mechanical small bowel obstruction in adults

Authors
Liliana Bordeianou, MD, MPH
Daniel Dante Yeh, MD
Section Editor
David I Soybel, MD
Deputy Editor
Wenliang Chen, MD, PhD

INTRODUCTION

Small bowel obstruction (SBO) occurs when the normal flow of intestinal contents is interrupted. The management of bowel obstruction depends upon the etiology, severity, and location of the obstruction. The goals of initial management are to relieve discomfort and restore normal fluid volume and electrolytes in preparation for possible surgical intervention. Some patients may be candidates for a trial of nonoperative management. High-quality data to guide management of SBO are sparse, and clinical practice is highly variable; however, guidelines based upon the available evidence are available from the Eastern Association for the Surgery of Trauma (EAST) [1,2], and from the World Society of Emergency Surgery (Bologna guidelines). The latter focuses on the management of adhesion-related small bowel obstruction [3,4].

This topic review will focus on the management of mechanical small bowel obstruction. The clinical features and diagnosis of mechanical small bowel obstruction are discussed separately. (See "Epidemiology, clinical features, and diagnosis of mechanical small bowel obstruction in adults".)

INITIAL MANAGEMENT

Patients with clinical features of small bowel obstruction (SBO) who are diagnosed with acute mechanical small bowel obstruction generally require admission to the hospital for initial management that includes intravenous fluid therapy and electrolyte replacement in preparation for surgery, if indicated, or as an element of nonoperative management. Patients with chronic and/or intermittent mechanical small bowel obstruction, such as patients with small bowel strictures related to Crohn’s disease, radiation enteritis, or other etiologies that can cause partial bowel obstruction, may be managed expectantly on an outpatient basis. Such patients should limit their oral intake to fluids, and as long as hydration and normal electrolyte balance can be maintained, which may require outpatient fluid therapy, hospitalization may be avoided. In a review of 129 patients, placement of a nasogastric tube to manage nausea and emesis predicted the need for admission, which occurred in about half of patients who presented to the emergency room with varying degrees and etiologies for small bowel obstruction [5].

Surgical consultation — For patients with symptoms that are severe enough to require admission for symptoms of abdominal pain, nausea, and vomiting, we suggest prompt surgical consultation to aid in determining if immediate surgical intervention is needed. (See 'Indications for surgical exploration' below.)


If surgery is not immediately indicated, we suggest admission to a dedicated surgical service unless such a service is not available or the patient is not a candidate for, or is unwilling to consider, an operation. (See 'Medical therapies' below.)

                     

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Literature review current through: Nov 2016. | This topic last updated: Wed May 18 00:00:00 GMT+00:00 2016.
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