Medscape is available in 5 Language Editions – Choose your Edition here.


Small-Bowel Obstruction Medication

  • Author: Brian A Nobie, MD; Chief Editor: Steven C Dronen, MD, FAAEM  more...
Updated: Jan 20, 2015

Medication Summary

Fluid replacement with aggressive intravenous (IV) resuscitation using isotonic saline or lactated Ringer solution is indicated. Oxygen and appropriate monitoring are also required. Antibiotics are used to cover gram-negative and anaerobic organisms. In addition, analgesia and antiemetic are administered as indicated clinically. As previously mentioned, a nonoperative trial of as many as 3 days is warranted for partial or simple obstruction. Resolution of obstruction occurs in virtually all patients with these lesions within 72 hours.



Class Summary

These agents are for prophylaxis in surgical intervention, if needed.



Cefazolin is a first-generation semisynthetic cephalosporin that arrests bacterial cell wall synthesis, inhibiting bacterial growth.

Cefoxitin (Mefoxin)


Cefoxitin is a second-generation cephalosporin indicated for gram-positive cocci and gram-negative rod infections. Infections caused by cephalosporin- or penicillin-resistant gram-negative bacteria may respond to cefoxitin.



Cefotetan is a second-generation cephalosporin indicated for infections caused by susceptible gram-positive cocci and gram-negative rods. Dosage and route of administration depend on the condition of patient, the severity of infection, and the susceptibility of the causative organism.

Cefuroxime (Ceftin, Zinacef)


Cefuroxime is a second-generation cephalosporin that maintains the gram-positive activity of first-generation cephalosporins; it adds activity against Proteus mirabilis, Haemophilus influenzae, E coli, Klebsiella pneumoniae, and Moraxella catarrhalis. The condition of the patient, the severity of the infection, and the susceptibility of the microorganism determine the proper dose and route of administration.

Meropenem (Merrem)


Meropenem is a bactericidal, broad-spectrum carbapenem antibiotic that inhibits cell-wall synthesis. It is effective against most gram-positive and gram-negative bacteria.



Class Summary

These agents should be administered for symptomatic relief, usually in conjunction with GI decompression via placement of an NG tube for suction.

Promethazine (Phenergan, Phenadoz, Promethegan)


Promethazine is for the symptomatic treatment of nausea and vomiting. It is an antidopaminergic agent that is effective in treating emesis. Promethazine blocks postsynaptic mesolimbic dopaminergic receptors in the brain and reduces stimuli to the brainstem reticular system.

Ondansetron (Zofran, Zuplenz)


Ondansetron is a selective 5-HT3-receptor antagonist that blocks serotonin peripherally and centrally; it is used in the prevention of nausea and vomiting. Ondansetron is metabolized in the liver through the P-450 pathway.



Class Summary

Pain control is essential to quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties, which are beneficial for patients who experience pain.

Morphine sulfate (Astramorph, MS Contin, Kadian, Duramorph)


This is the drug of choice for analgesia due to its reliable and predictable effects, safety profile, and ease of reversibility with naloxone. Various IV doses are used; morphine sulfate is commonly titrated until the desired effect is obtained.

Contributor Information and Disclosures

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

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

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 Association for Physician Leadership, American Medical Association, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

  1. Zerey M, Sechrist CW, Kercher KW, Sing RF, Matthews BD, Heniford BT. The laparoscopic management of small-bowel obstruction. Am J Surg. 2007 Dec. 194(6):882-7; discussion 887-8. [Medline].

  2. Khaikin M, Schneidereit N, Cera S, Sands D, Efron J, Weiss EG, et al. Laparoscopic vs. open surgery for acute adhesive small-bowel obstruction: patients' outcome and cost-effectiveness. Surg Endosc. 2007 May. 21(5):742-6. [Medline].

  3. van der Wal JB, Iordens GI, Vrijland WW, van Veen RN, Lange J, Jeekel J. Adhesion prevention during laparotomy: long-term follow-up of a randomized clinical trial. Ann Surg. 2011 Jun. 253(6):1118-21. [Medline].

  4. Di Saverio S, Coccolini F, Galati M, Smerieri N, Biffl WL, Ansaloni L, et al. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg. 2013 Oct 10. 8(1):42. [Medline].

  5. Thompson WM, Kilani RK, Smith BB, Thomas J, Jaffe TA, Delong DM, et al. Accuracy of abdominal radiography in acute small-bowel obstruction: does reviewer experience matter?. AJR Am J Roentgenol. 2007 Mar. 188(3):W233-8. [Medline].

  6. Lappas JC, Reyes BL, Maglinte DD. Abdominal radiography findings in small-bowel obstruction: relevance to triage for additional diagnostic imaging. AJR Am J Roentgenol. 2001 Jan. 176(1):167-74. [Medline].

  7. Sheedy SP, Earnest F 4th, Fletcher JG, Fidler JL, Hoskin TL. CT of small-bowel ischemia associated with obstruction in emergency department patients: diagnostic performance evaluation. Radiology. 2006 Dec. 241(3):729-36. [Medline].

  8. Diaz JJ Jr, Bokhari F, Mowery NT, Acosta JA, Block EF, Bromberg WJ, et al. Guidelines for management of small bowel obstruction. J Trauma. 2008 Jun. 64(6):1651-64. [Medline].

  9. Kim JH, Ha HK, Sohn MJ, Shin BS, Lee YS, Chung SY, et al. Usefulness of MR imaging for diseases of the small intestine: comparison with CT. Korean J Radiol. 2000 Jan-Mar. 1(1):43-50. [Medline]. [Full Text].

  10. Beall DP, Fortman BJ, Lawler BC, Regan F. Imaging bowel obstruction: a comparison between fast magnetic resonance imaging and helical computed tomography. Clin Radiol. 2002 Aug. 57(8):719-24. [Medline].

  11. Regan F, Beall DP, Bohlman ME, Khazan R, Sufi A, Schaefer DC. Fast MR imaging and the detection of small-bowel obstruction. AJR Am J Roentgenol. 1998 Jun. 170(6):1465-9. [Medline].

  12. Raptopoulos V, Schwartz RK, McNicholas MM, Movson J, Pearlman J, Joffe N. Multiplanar helical CT enterography in patients with Crohn's disease. AJR Am J Roentgenol. 1997 Dec. 169(6):1545-50. [Medline].

  13. Bodily KD, Fletcher JG, Solem CA, Johnson CD, Fidler JL, Barlow JM, et al. Crohn Disease: mural attenuation and thickness at contrast-enhanced CT Enterography--correlation with endoscopic and histologic findings of inflammation. Radiology. 2006 Feb. 238(2):505-16. [Medline].

  14. Engin G. Computed tomography enteroclysis in the diagnosis of intestinal diseases. J Comput Assist Tomogr. 2008 Jan-Feb. 32(1):9-16. [Medline].

  15. Rajesh A, Maglinte DD. Multislice CT enteroclysis: technique and clinical applications. Clin Radiol. 2006 Jan. 61(1):31-9. [Medline].

  16. Gollub MJ. Multidetector computed tomography enteroclysis of patients with small bowel obstruction: a volume-rendered "surgical perspective". J Comput Assist Tomogr. 2005 May-Jun. 29(3):401-7. [Medline].

  17. Cappell MS, Batke M. Mechanical obstruction of the small bowel and colon. Med Clin North Am. 2008 May. 92(3):575-97, viii. [Medline].

  18. Jang TB, Schindler D, Kaji AH. Bedside ultrasonography for the detection of small bowel obstruction in the emergency department. Emerg Med J. 2011 Aug. 28(8):676-8. [Medline].

  19. Fevang BT, Fevang J, Stangeland L, Soreide O, Svanes K, Viste A. Complications and death after surgical treatment of small bowel obstruction: A 35-year institutional experience. Ann Surg. 2000 Apr. 231(4):529-37. [Medline]. [Full Text].

  20. Cirocchi R, Abraha I, Farinella E, Montedori A, Sciannameo F. Laparoscopic versus open surgery in small bowel obstruction. Cochrane Database Syst Rev. 2010 Feb 17. CD007511. [Medline].

  21. Alhilli MM, El-Nashar SA, Garrett AT, Weaver AL, Famuyide AO. Use of Computed Tomography in the Diagnosis of Bowel Complications After Gynecologic Surgery. Obstet Gynecol. 2013 Nov 6. [Medline].

  22. Henderson D. Postop CT Scans May Fail to Detect Bowel Obstruction. Medscape [serial online]. Available at Accessed: November 18, 2013.

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.
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.