Small-Bowel Obstruction Clinical Presentation

  • Author: Brian A Nobie, MD, FACEP; Chief Editor: Steven C Dronen, MD, FAAEM   more...
 
Updated: Oct 5, 2011
 

History

Obstruction can be characterized as either partial or complete versus simple or strangulated. No accurate clinical picture exists to detect early strangulation of obstruction.

Abdominal pain, often described as crampy and intermittent, is more prevalent in simple obstruction. Often, the presentation may provide clues to the approximate location and nature of the obstruction. Usually, pain that occurs for a shorter duration of time and is colicky and accompanied by bilious vomiting may be more proximal. Pain that lasts as long as several days, is progressive in nature, and is accompanied by abdominal distention may be typical of a more distal obstruction.

Changes in the character of the pain may indicate the development of a more serious complication (ie, constant pain of a strangulated or ischemic bowel).

Patients also report the following:

  • Nausea
  • Vomiting - Associated more with proximal obstructions
  • Diarrhea - An early finding
  • Constipation - A late finding, as evidenced by the absence of flatus or bowel movements
  • Fever and tachycardia - Occur late and may be associated with strangulation
  • Previous abdominal or pelvic surgery, previous radiation therapy, or both - May be part of the patient's medical history
  • History of malignancy - Particularly ovarian and colonic malignancy
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Physical Examination

Abdominal distention is present. The duodenal or proximal small bowel has less distention when obstructed than the distal bowel has when obstructed. Hyperactive bowel sounds occur early as GI contents attempt to overcome the obstruction; hypoactive bowel sounds occur late.

Exclude incarcerated hernias of the groin, femoral triangle, and obturator foramina. Proper genitourinary and pelvic examinations are essential. Look for the following during rectal examination:

  • Gross or occult blood, which suggests late strangulation or malignancy
  • Masses, which suggest obturator hernia

Check for symptoms commonly believed to be more diagnostic of intestinal ischemia, including the following:

  • Fever (temperature >100°F)
  • Tachycardia (>100 beats/min)
  • Peritoneal signs

No reliable way exists to differentiate simple from early strangulated obstruction on physical examination. Serial abdominal examinations are important and may detect changes early.

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Contributor Information and Disclosures
Author

Brian A Nobie, MD, FACEP  Director of Recruitment, Consulting Staff, Florida Emergency Physicians, Florida Hospital, Celebration Health

Brian A Nobie, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Joseph J Sachter, MD, FACEP  Consulting Staff, Department of Emergency Medicine, Muhlenberg Regional Medical Center

Joseph J Sachter, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Chief Editor

Steven C Dronen, MD, FAAEM  Chair, Department of Emergency Medicine, LeConte Medical Center

Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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Small bowel obstruction. Image courtesy of Ademola Adewale, MD.
Small bowel obstruction. Image courtesy of Ademola Adewale, MD.
Small bowel obstruction. Image courtesy of Ademola Adewale, MD.
 
 
 
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