Home

Loading...

Table of contents

Small bowel obstruction

Background

Overview

Definition
SBO is a clinical syndrome characterized by symptoms related to mechanical blockage of the small bowel.
1
Pathophysiology
Common etiologies include adhesions (65%), hernias (10%), neoplasms (5%), and Crohn's disease (5%).
2
Epidemiology
In the US, the incidence of SBO is approximately 100 per 100,000 person-years.
2
Disease course
The distension of small bowel segments that are proximal to the obstruction may lead to clinical manifestations of abdominal pain, nausea, and vomiting. Bacterial translocation can result in bacteremia. Progressive, untreated obstruction may lead to bowel ischemia and perforation, with secondary fecal peritonitis.
3
Prognosis and risk of recurrence
In patients with SBO due to postoperative adhesions, in-hospital mortality is estimated at 4.7%. In patients undergoing emergency laparotomy for SBO, 1-month mortality is estimated at 7.2%.
4
5

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of small bowel obstruction are prepared by our editorial team based on guidelines from the World Society of Emergency Surgery (WSES 2018) and the Eastern Association for the Surgery of Trauma (EAST 2012). ...
Show more

Diagnostic investigations

Initial evaluation
As per WSES 2018 guidelines:
Obtain basic laboratory tests (CBC, lactate, electrolytes, serum creatinine and urea) as part of the initial evaluation of patients with SBO.
B
Assess the nutritional status of patients presenting with SBO.
B
Create free account

More topics in this section

  • Abdominal radiographs

  • Abdominal CT

  • Abdominal MRI and ultrasound

Medical management

Setting of care: as per EAST 2012 guidelines, consider admitting patients with SBO to a surgical service, as this has been shown to be associated with a shorter length of stay and lower mortality as compared with admission to a medical service.
C

More topics in this section

  • Supportive management

Surgical interventions

Indications for surgery: as per EAST 2012 guidelines, perform timely surgical exploration in patients with SBO and generalized peritonitis on physical examination or with other evidence of clinical deterioration such as fever, leukocytosis, tachycardia, metabolic acidosis, and continuous pain.
A
Show 2 more

More topics in this section

  • Laparoscopic surgery

  • Adhesion barriers

Specific circumstances

Pediatric patients: as per WSES 2018 guidelines, consider methods of adhesion prevention in younger patients, and pediatric patients in particular.
C

More topics in this section

  • Patients with diabetes