Small Bowel Obstruction
DefinitionSmall bowel obstruction means the small intestine is partially or totally blocked. When this happens, the contents of the intestine cannot properly get out of the body. Stools, fluid, and gas build up inside the intestine. This is a potentially serious condition that requires urgent medical care.
CausesBowel obstruction may be caused by a mechanical problem. In this case, something inside the body blocks the movement of material through the intestine. It can also be caused by an ileus, which is when the intestine itself does not work right. This nonmechanical type of obstruction is called paralytic ileus , or pseudo-obstruction. It is often the cause of obstruction in infants and children. Mechanical small bowel obstruction may be caused by:
- Adhesions—scar tissue left behind, in most cases by previous abdominal surgery
- Intussusception —telescoping of the intestinal wall
- Volvulus—the intestine twists on itself
- Impacted foreign bodies—items that were swallowed and got stuck
|Small Bowel Obstruction|
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Risk FactorsFactors that may increase your chance of having a small bowel obstruction include:
- Crohn’s disease —an inflammatory bowel condition
- Abdominal, joint, or spine surgery
- Swallowing a foreign body
- Decreased blood supply to the small bowel
- Abnormal growth of tissue in or next to the small intestine
- Tumors in the small intestine
- Infection in the lining of the small intestine
- Kidney disease
- Long-standing diabetes
- Rarely, gallstones
SymptomsSymptoms of small bowel obstruction often occur in combination. Small bowel obstruction may cause:
- Abdominal fullness and/or excessive gas
- Distension—abdomen feels stretched out more than normal
- Pain and cramps in stomach area
- Bad breath
DiagnosisYou will be asked about your symptoms and medical history. A physical exam will be done. The exam will include listening for bowel sounds in your stomach. Very high pitched bowel sounds heard through a stethoscope suggest mechanical bowel obstruction. Conversely, paralytic ileus often produces no bowel sounds.Imaging tests are used to evaluate abdominal structures. These may include:
TreatmentTreatment depends on the cause and severity of the obstruction. You will usually require treatment by a specialist. Your doctor will also treat you for any underlying conditions that contribute to small bowel obstruction.
Initial CareBefore any surgical treatment or procedure can begin, you may need to be stabilized. This may include:
- Monitoring and IV fluids —observation at a hospital may be needed to see if the blockage will get better on its own. No food will be allowed and fluids will be given through an IV.
- Nasogastric tube —A tube is inserted through the nose and into the stomach to remove fluids and gas, which can promptly relieve pain and pressure. It will be left in place until the intestines are working well.
- Catheterization —A tube is placed in the bladder to drain and test urine.
MedicationsMedications may include:
- Pain relievers
- Oral triple therapy—to reduce gas, bloating, and improve symptoms
- Muscle stimulants—to promote muscle contraction in the intestine
- Antibiotics—to treat bacterial infections
SurgerySurgery may be needed if you do not respond to medical treatment, or in the following circumstances:
- Intestinal strangulation, which may be caused by volvulus or intussusception
- Abdominal adhesions
PreventionThere are no current guidelines to prevent small bowel obstruction. Managing any underlying conditions, such as Crohn’s disease, can reduce your chances.
National Cancer Institute
National Institute of Diabetes and Digestive and Kidney Diseases
Canadian Association of Gastroenterology
Crohn's and Colitis Foundation of Canada
Abdominal adhesions. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/intestinaladhesions/index.aspx. Updated September 11, 2013. Accessed December 18, 2014.
Baron TH. Acute colonic obstruction. Gastrointest Endosc Clin N Am. 2007(17)2:323-329.
Bonin EA, Baron TH.Update on the indications and use of colonic stents.Curr Gastroenterol Rep. 2010;12(5):374-382.
Gastrointestinal complications (PDQ): health professionals. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/pdq/supportivecare/gastrointestinalcomplications/healthprofessional. Updated August 28, 2014. Accessed December 18, 2014.
Intestinal pseudo-obstruction. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/intestinalpo. Updated February 26, 2014. Accessed December 18, 2014.
Kulaylat MN, Doerr RJ. Small bowel obstruction. Available at: http://www.ncbi.nlm.nih.gov/books/NBK6873. Published 2001. Accessed December 18, 2014.
Small bowel obstruction. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 2, 2014. Accessed December 18, 2014.
4/7/2014 DynaMed's Systematic Literature Surveillance. http://www.ebscohost.com/dynamed: Katz DS, Baker ME, et al. Suspected small bowel obstruction. American College of Radiology (ACR) Appropriateness Criteria. Available at: http://www.acr.org/~/media/832F100277004BC69A8C818C7C9BFF33.pdf. Updated 2013. Accessed December 18, 2014.
- Reviewer: Daus Mahnke, MD
- Review Date: 12/2014
- Update Date: 12/20/2014
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