Small bowel obstruction - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Small bowel obstruction is a mechanical disruption in the patency of the gastrointestinal tract.
It is a medical emergency that requires early diagnosis and potential surgical intervention.
It typically presents with the combined symptoms of abdominal pain, bloating, vomiting, and failure to pass flatus or stool per rectum.
Diagnosis is generally based upon clinical and radiographic features.
Treatment involves a combination of nasogastric decompression and intravenous fluids. Surgery may be required, so the diagnosis requires urgent surgical assessment.

Abdominal x-ray showing partial intestinal obstruction

From the collection of Dr David J. Hackam

Quick Reference

History & Exam
- Key Factors
- Other Factors
More information...
Diagnostics Tests
More information...
Treatment Options
More information...

Definition

Epidemiology

Etiology

Pathophysiology

Images

Abdominal CT scan showing small bowel obstruction with multiple air-fluid levels, dilated bowel loops and a transition zone in the right iliac fossa. Red arrows indicate the evident transition zone
Abdominal x-ray showing partial intestinal obstruction
Abdominal x-ray showing complete intestinal obstruction

Citations

Key Articles

Maung AA, Johnson DC, Piper GL, et al; Eastern Association for the Surgery of Trauma. Evaluation and management of small-bowel obstruction: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012 Nov;73(5 suppl 4):S362-9.[Abstract][Full Text]
Jackson P, Vigiola Cruz M. Intestinal obstruction: evaluation and management. Am Fam Physician. 2018 Sep 15;98(6):362-7.[Abstract]
American College of Radiology. ACR appropriateness criteria: suspected small-bowel obstruction. 2019 [internet publication].[Full Text]
Li Z, Zhang L, Liu X, et al. Diagnostic utility of CT for small bowel obstruction: systematic review and meta-analysis. PLoS One. 2019;14(12):e0226740.[Abstract][Full Text]
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.[Abstract][Full Text]

Referenced Articles

1. Maung AA, Johnson DC, Piper GL, et al; Eastern Association for the Surgery of Trauma. Evaluation and management of small-bowel obstruction: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012 Nov;73(5 suppl 4):S362-9.[Abstract][Full Text]
2. Hill AG. The management of adhesive small bowel obstruction - an update. Int J Surg. 2008 Feb;6(1):77-80.[Abstract][Full Text]
3. Jeong WK, Lim SB, Choi HS, et al. Conservative management of adhesive small bowel obstructions in patients previously operated on for primary colorectal cancer. J Gastrointest Surg. 2008 May;12(5):926-32.[Abstract]
4. Attard JA, MacLean AR. Adhesive small bowel obstruction: epidemiology, biology and prevention. Can J Surg. 2007 Aug;50(4):291-300.[Abstract][Full Text]
5. Tsao KJ, St Peter SD, Valusek PA, et al. Adhesive small bowel obstruction after appendectomy in children: comparison between the laparoscopic and open approach. J Pediatr Surg. 2007 Jun;42(6):939-42.[Abstract]
6. Yamada T, Okabayashi K, Hasegawa H, et al. Meta-analysis of the risk of small bowel obstruction following open or laparoscopic colorectal surgery. Br J Surg. 2016 Apr;103(5):493-503.[Abstract]
7. Ha GW, Lee MR, Kim JH. Adhesive small bowel obstruction after laparoscopic and open colorectal surgery: a systematic review and meta-analysis. Am J Surg. 2016 Sep;212(3):527-36.[Abstract]
8. Pecorelli N, Greco M, Amodeo S, et al. Small bowel obstruction and incisional hernia after laparoscopic and open colorectal surgery: a meta-analysis of comparative trials. Surg Endosc. 2017 Jan;31(1):85-99.[Abstract]
9. Brüggmann D, Tchartchian G, Wallwiener M, et al. Intra-abdominal adhesions: definition, origin, significance in surgical practice, and treatment options. Dtsch Arztebl Int. 2010 Nov;107(44):769-75.[Abstract][Full Text]
10. Kumar S, Wong PF, Leaper DJ. Intra-peritoneal prophylactic agents for preventing adhesions and adhesive intestinal obstruction after non-gynaecological abdominal surgery. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD005080.[Abstract][Full Text]
11. Petrovic B, Nikolaidis P, Hammond NA, et al. Identification of adhesions on CT in small-bowel obstruction. Emerg Radiol. 2006 Mar;12(3):88-93.[Abstract]
12. Taylor MR, Lalani N. Adult small bowel obstruction. Acad Emerg Med. 2013 Jun;20(6):528-44.[Abstract][Full Text]
13. Rami Reddy SR, Cappell MS. A systematic review of the clinical presentation, diagnosis, and treatment of small bowel obstruction. Curr Gastroenterol Rep. 2017 Jun;19(6):28.[Abstract]
14. Jackson P, Vigiola Cruz M. Intestinal obstruction: evaluation and management. Am Fam Physician. 2018 Sep 15;98(6):362-7.[Abstract]
15. Breum BM, Rud B, Kirkegaard T, et al. Accuracy of abdominal auscultation for bowel obstruction. World J Gastroenterol. 2015 Sep 14;21(34):10018-24.[Abstract][Full Text]
16. American College of Radiology. ACR appropriateness criteria: suspected small-bowel obstruction. 2019 [internet publication].[Full Text]
17. Li Z, Zhang L, Liu X, et al. Diagnostic utility of CT for small bowel obstruction: systematic review and meta-analysis. PLoS One. 2019;14(12):e0226740.[Abstract][Full Text]
18. 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.[Abstract][Full Text]
19. Millet I, Taourel P, Ruyer A, et al. Value of CT findings to predict surgical ischemia in small bowel obstruction: a systematic review and meta-analysis. Eur Radiol. 2015 Jun;25(6):1823-35.[Abstract]
20. Zhou J, Cong R, Shi J, et al. Diagnostic significance of multidetector computed tomography (MDCT) in patients with small bowel obstruction: a meta-analysis. Jpn J Radiol. 2020 May;38(5):458-62.[Abstract][Full Text]
21. Branco BC, Barmparas G, Schnüriger B, et al. Systematic review and meta-analysis of the diagnostic and therapeutic role of water-soluble contrast agent in adhesive small bowel obstruction. Br J Surg. 2010 Apr;97(4):470-8.[Abstract][Full Text]
22. 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]
23. Simundic AM, Bölenius K, Cadamuro J, et al. Joint EFLM-COLABIOCLI recommendation for venous blood sampling. Clin Chem Lab Med. 2018;56(12):2015-38.[Abstract]
24. Sajja SB, Schein M. Early postoperative small bowel obstruction. Br J Surg. 2004 Jun;91(6):683-91.[Abstract][Full Text]
25. Medicines and Healthcare products Regulatory Agency. Clozapine: reminder of potentially fatal risk of intestinal obstruction, faecal impaction, and paralytic ileus. Oct 2017 [internet publication].[Full Text]
26. American College of Radiology; Society for Pediatric Radiology. ACR-SPR practice parameter for the performance of a contrast small bowel examination. 2023 [internet publication].[Full Text]
27. Klingbeil KD, Wu JX, Osuna-Garcia A, et al. Management of small bowel obstruction and systematic review of treatment without nasogastric tube decompression. Surg Open Sci. 2022 Nov 7;12:62-7.[Abstract][Full Text]
28. Fonseca AL, Schuster KM, Maung AA, et al. Routine nasogastric decompression in small bowel obstruction: is it really necessary? Am Surg. 2013 Apr;79(4):422-8.[Abstract]
29. Chen SC, Lee CC, Yen ZS, et al. Specific oral medications decrease the need for surgery in adhesive partial small-bowel obstruction. Surgery. 2006 Mar;139(3):312-6.[Abstract]
30. Koh A, Adiamah A, Chowdhury A, et al. Therapeutic role of water-soluble contrast media in adhesive small bowel obstruction: a systematic review and meta-analysis. J Gastrointest Surg. 2020 Feb;24(2):473-83.[Abstract]
31. Scotté M, Mauvais F, Bubenheim M, et al. Use of water-soluble contrast medium (gastrografin) does not decrease the need for operative intervention nor the duration of hospital stay in uncomplicated acute adhesive small bowel obstruction? a multicenter, randomized, clinical trial (adhesive small bowel obstruction study) and systematic review. Surgery. 2017 May;161(5):1315-25.[Abstract]
32. Sajid MS, Khawaja AH, Sains P, et al. A systematic review comparing laparoscopic vs open adhesiolysis in patients with adhesional small bowel obstruction. Am J Surg. 2016 Jul;212(1):138-50.[Abstract]
33. Wiggins T, Markar SR, Harris A. Laparoscopic adhesiolysis for acute small bowel obstruction: systematic review and pooled analysis. Surg Endosc. 2015 Dec;29(12):3432-42.[Abstract]
34. Quah GS, Eslick GD, Cox MR. Laparoscopic versus open surgery for adhesional small bowel obstruction: a systematic review and meta-analysis of case-control studies. Surg Endosc. 2019 Oct;33(10):3209-17.[Abstract][Full Text]
35. Krielen P, Di Saverio S, Ten Broek R, et al. Laparoscopic versus open approach for adhesive small bowel obstruction, a systematic review and meta-analysis of short term outcomes. J Trauma Acute Care Surg. 2020 Jun;88(6):866-74.[Abstract]
36. Navaneethan U, Lourdusamy V, Njei B, et al. Endoscopic balloon dilation in the management of strictures in Crohn's disease: a systematic review and meta-analysis of non-randomized trials. Surg Endosc. 2016 Dec;30(12):5434-43.[Abstract]
37. Baars JE, Theyventhiran R, Aepli P, et al. Double-balloon enteroscopy-assisted dilatation avoids surgery for small bowel strictures: a systematic review. World J Gastroenterol. 2017 Dec 7;23(45):8073-81.[Abstract][Full Text]
38. Bettenworth D, Bokemeyer A, Kou L, et al. Systematic review with meta-analysis: efficacy of balloon-assisted enteroscopy for dilation of small bowel Crohn's disease strictures. Aliment Pharmacol Ther. 2020 Oct;52(7):1104-16.[Abstract]
39. Cousins SE, Tempest E, Feuer DJ. Surgery for the resolution of symptoms in malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer. Cochrane Database Syst Rev. 2016 Jan 4;(1):CD002764.[Abstract][Full Text]
40. Santangelo ML, Grifasi C, Criscitiello C, et al. Bowel obstruction and peritoneal carcinomatosis in the elderly: a systematic review. Aging Clin Exp Res. 2017 Feb;29(Suppl 1):73-8.[Abstract]
41. Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt). 2013 Feb;14(1):73-156.[Full Text]
42. Kusminsky RE. Complications of central venous catheterization. J Am Coll Surg. 2007 Apr;204(4):681-96.[Abstract]
43. McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med. 2003 Mar 20;348(12):1123-33.[Abstract][Full Text]
44. Smith RN, Nolan JP. Central venous catheters. BMJ. 2013 Nov 11;347:f6570.[Abstract][Full Text]
45. Reich DL. Monitoring in anesthesia and perioperative care. Cambridge: Cambridge University Press; 2011.
46. Abbott Northwestern Hospital Internal Medicine Residency. Internal jugular central venous line. 2022 [internet publication].[Full Text]
47. Bishop L, Dougherty L, Bodenham A, et al. Guidelines on the insertion and management of central venous access devices in adults. Int J Lab Hematol. 2007 Aug;29(4):261-78.[Abstract]
48. Practice guidelines for central venous access 2020: an updated report by the American Society of Anesthesiologists Task Force on Central Venous Access. Anesthesiology. 2020 Jan;132(1):8-43.[Abstract][Full Text]
49. Fletcher SJ, Bodenham AR. Safe placement of central venous catheters: where should the tip of the catheter lie? Br J Anaesth. 2000 Aug;85(2):188-91.[Abstract]
50. Gibson F, Bodenham A. Misplaced central venous catheters: applied anatomy and practical management. Br J Anaesth. 2013 Mar;110(3):333-46.[Abstract][Full Text]
51. Schuster M, Nave H, Piepenbrock S, et al. The carina as a landmark in central venous catheter placement. Br J Anaesth. 2000 Aug;85(2):192-4.[Abstract]
52. Webster J, Osborne S, Rickard CM, et al. Clinically-indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database Syst Rev. 2019 Jan 23;(1):CD007798.[Abstract][Full Text]
53. Royal College of Nursing. Catheter care: RCN guidance for health care professionals. Jul 2021 [internet publication].[Full Text]
54. Royal College of Nursing. Catheter care: guidance for health care professionals. Jul 2021 [internet publication].[Full Text]
55. NHS Improvement. Patient Safety review and response: April to September 2018. March 2019 [internet publication].[Full Text]
56. NHS England. Patient safety alert on placement devices for nasogastric tube insertion. December 2019 [internet publication].[Full Text]
57. Roeland E, von Gunten CF. Current concepts in malignant bowel obstruction management. Curr Oncol Rep. 2009 Jul;11(4):298-303.[Abstract]
58. Ripamonti CI, Easson AM, Gerdes H. Management of malignant bowel obstruction. Eur J Cancer. 2008 May;44(8):1105-15.[Abstract]
59. Canadian Association of General Surgeons. Dynamic practice guidelines for emergency general surgery: small bowel obstruction. 2018 [internet publication].[Full Text]
60. Chai Y, Xing J, Lv P, et al. Evaluation of ischemia and necrosis in adhesive small bowel obstruction based on CT signs: subjective visual evaluation and objective measurement. Eur J Radiol. 2022 Feb;147:110115.[Abstract]
61. Yang TWW, Prabhakaran S, Bell S, et al. Non-operative management for small bowel obstruction in a virgin abdomen: a systematic review. ANZ J Surg. 2021 May;91(5):802-9.[Abstract]