eMedicine Specialties > Emergency Medicine > Gastrointestinal

Obstruction, Small Bowel: Follow-up

Author: Brian A Nobie FACEP, MD, Director of Recruitment, Consulting Staff, Florida Emergency Physicians, Florida Hospital, Celebration Health
Contributor Information and Disclosures

Updated: Aug 17, 2009

Follow-up

Further Inpatient Care

  • Continued NG suction: This provides symptomatic relief, decreases the need for intraoperative decompression, and benefits all patients. No clinical advantage to using a long tube (nasointestinal) instead of a short tube (NG) is observed.
  • Nonoperative treatment: A nonoperative trial of as many as 3 days is warranted for partial or simple obstruction. Provide adequate fluid resuscitation and NG suctioning. Resolution of obstruction occurs in virtually all patients with these lesions within 72 hours.
  • Good data regarding nonoperative management suggest it to be successful in 65-81% of partial SBO cases without peritonitis.2,10
  • Surgical treatment: A strangulated obstruction is a surgical emergency. In patients with a complete SBO, the risk of strangulation is high and early surgical intervention is warranted. Patients with simple complete obstructions in whom nonoperative trials fail also need surgical treatment but experience no apparent disadvantage to delayed surgery.
  • Laparoscopy has been shown to be safe and effective in selected cases of SBO.11
  • Adhesions: Decreasing intraoperative trauma to the peritoneal surfaces can prevent adhesion formation.
  • Malignant tumor: Obstruction by tumor is usually caused by metastasis. Initial treatment should be nonoperative; surgical resection is recommended when feasible.
  • Inflammatory bowel disease: To reduce the inflammatory process, treatment generally is nonoperative in combination with high-dose steroids. Consider parenteral treatment for prolonged periods of bowel rest. Undertake surgical treatment, bowel resection, and/or stricturoplasty if nonoperative treatment fails.
  • Intra-abdominal abscess: CT-guided drainage is usually sufficient to relieve obstruction.
  • Radiation enteritis: If obstruction follows radiation therapy acutely, nonoperative treatment accompanied by steroids is usually sufficient. If obstruction is a chronic sequela of radiation therapy, surgical treatment is indicated.
  • Acute postoperative obstruction: This is difficult to diagnose because symptoms often are attributed to incisional pain and postoperative ileus. Treatment should be nonoperative.
  • Incarcerated hernia: Initially use manual reduction and observation. Advise elective hernia repair as soon as possible after reduction.

Further Outpatient Care

  • Treat all patients as inpatients including trial of observation.

Complications

  • Sepsis
  • Intra-abdominal abscess
  • Wound dehiscence
  • Aspiration
  • Short-bowel syndrome (as a result of multiple surgeries)
  • Death (secondary to delayed treatment)

Prognosis

  • With proper diagnosis and treatment of the obstruction, prognosis is good. Complete obstructions treated successfully nonoperatively have a higher incidence of recurrence than those treated surgically.

Miscellaneous

Medicolegal Pitfalls

  • No accurate clinical picture exists to detect early strangulation of obstruction.
  • If the diagnosis is unclear, admission and observation are warranted to detect early obstructions.
  • Some factors associated with death and postoperative complications include age, comorbidity, and treatment delay. According to one Norwegian group, morbidity and mortality decreased from 1961 to 1995.
 


More on Obstruction, Small Bowel

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Treatment & Medication: Obstruction, Small Bowel
Follow-up: Obstruction, Small Bowel
Multimedia: Obstruction, Small Bowel
References
Further Reading
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References

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Further Reading

Clinical guidelines

EAST Practice Parameter Workgroup for Management of Small Bowel Obstruction. Practice management guidelines for small bowel obstruction. Chicago (IL): Eastern Association for the Surgery of Trauma (EAST); 2007. 42 p.

Ros PR, Huprich JE, Bree RL, Foley WD, Gay SB, Glick SN, Heiken JP, Levine MS, Rosen MP, Shuman WP, Greene FL, Expert Panel on Gastrointestinal Imaging. Suspected small bowel obstruction. [online publication]. Reston (VA): American College of Radiology (ACR); 2005. 5 p.

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Keywords

SBO, small bowel obstruction, small-bowel obstruction, obstruction of the small bowel, partial SBO, complete SBO, simple SBO, nonstrangulated SBO, strangulated SBO, postoperative adhesion, malignancy, Crohn disease, Crohn's disease, hernia, bowel necrosis, bowel ischemia, perforation, peritonitis, inflammatory bowel disease, volvulus, congenital atresia, pyloric stenosis, intussusception

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Contributor Information and Disclosures

Author

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

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Eugene Hardin, MD, FAAEM, FACEP, Former Chair and Associate Professor, Department of Emergency Medicine, Charles Drew University of Medicine and Science; Former Chair, Department of Emergency Medicine, Martin Luther King Jr/Drew Medical Center
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD 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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