eMedicine Specialties > Pediatrics: General Medicine > Gastroenterology

Small-Bowel Obstruction: Follow-up

Author: Jaime Shalkow, MD, Head of Surgical Oncology, Division of Surgery, National Institute of Pediatrics, Mexico; Head-Professor of Pediatric Surgical Oncology, Universidad Nacional Autonoma de Mexico
Coauthor(s): Jose Asz, MD, Professor of Embryology, Assistant Professor of Surgery and Pediatrics, Faculty of Medicine, Universidad Nacional Autonoma de Mexico; Consulting Staff, Department of General Surgery, National Institute of Pediatrics, Mexico; Nicholas A Shorter, MD, Professor of Clinical Surgery and Clinical Pediatrics, State University of New York-Downstate University; Division Chief, Department of Surgery, Division of Pediatric Surgery, State University of New York-Downstate Medical Center; Bruce Friedberg, MD, Staff Physician, Department of Emergency Medicine, Mount Diablo Medical Center; Mainor Antillon, MD, Director, Pancreaticobiliary Endoscopy and Endosonography Program, Department of Internal Medicine, Division of Gastroenterology, King-Drew Medical Center; Associate Clinical Professor, Department of Medicine, University of California at Los Angeles; Thomas Tsou, MD, Director of Fast Tract and Pediatrics, Associate Professor, Departments of Medicine and Emergency Medicine, Charles R Drew University and University of California at Los Angeles
Contributor Information and Disclosures

Updated: Nov 21, 2008

Follow-up

Further Inpatient Care

  • Patients with partial small-bowel obstructions can be nonoperatively treated with adequate fluid resuscitation and nasoenteric suctioning.
  • Patients who do not respond to nonoperative treatment within 12-24 hours require surgical treatment.
  • After nonoperative hernia reduction, elective repair may be accomplished 24-48 hours after the edema subsides.
  • Admit any child with an intussusception that is successfully reduced with a barium enema for observation because this condition has a high reoccurrence rate, especially in the first 24 hours.

Further Outpatient Care

  • Close follow-up observation is mandatory for patients whose partial small-bowel obstructions are nonoperatively treated and who are stable for discharge.
  • Instruct parents that they must take their child immediately to an ED if the child's symptoms (eg, vomiting, pain) recur.

Complications

  • Bowel necrosis
  • Bowel perforation
  • Sepsis
  • Shock
  • Abscess
  • Short bowel syndrome with malabsorption and malnutrition
  • Death
  • Testicular infarction and atrophy, lesion to the testicular vessels or vas deferens, hernia recurrence (complications of incarcerated hernias)

Prognosis

  • The prognosis of small-bowel obstruction depends on the location and source of obstruction and on the extent of bowel necrosis.
  • With early diagnosis and treatment, the prognosis is good; however, mortality rates may reach 65% if more than 75% of the small bowel is necrotic at the time of laparotomy.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Signs and symptoms of bowel obstruction, especially in newborns, may be subtle; physicians should maintain a high index of suspicion.
  • Rapid decisions about the need for surgical intervention can mean the difference between full recovery and massive bowel loss.
  • Bilious vomiting in a newborn should immediately lead physicians to suspect a bowel obstruction and to initiate an immediate workup and a surgical consultation.
  • Admit any child with suspected small-bowel obstruction for observation, even if the diagnosis of obstruction is unclear.
 


More on Small-Bowel Obstruction

Overview: Small-Bowel Obstruction
Differential Diagnoses & Workup: Small-Bowel Obstruction
Treatment & Medication: Small-Bowel Obstruction
Follow-up: Small-Bowel Obstruction
Multimedia: Small-Bowel Obstruction
References
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References

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Further Reading

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Keywords

small-bowel obstruction, small bowel obstruction, SBO, intussusception, incarcerated hernia, malrotation of the bowel with midgut volvulus, postoperative adhesive small bowel obstruction, duplication cysts, annular pancreas, necrotizing enterocolitis, NEC, mesocolic hernia, cecal volvulus, jejunoileal atresia and stenosis, meconium Ileus

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Contributor Information and Disclosures

Author

Jaime Shalkow, MD, Head of Surgical Oncology, Division of Surgery, National Institute of Pediatrics, Mexico; Head-Professor of Pediatric Surgical Oncology, Universidad Nacional Autonoma de Mexico
Disclosure: Nothing to disclose.

Coauthor(s)

Jose Asz, MD, Professor of Embryology, Assistant Professor of Surgery and Pediatrics, Faculty of Medicine, Universidad Nacional Autonoma de Mexico; Consulting Staff, Department of General Surgery, National Institute of Pediatrics, Mexico
Disclosure: Nothing to disclose.

Nicholas A Shorter, MD, Professor of Clinical Surgery and Clinical Pediatrics, State University of New York-Downstate University; Division Chief, Department of Surgery, Division of Pediatric Surgery, State University of New York-Downstate Medical Center
Disclosure: Nothing to disclose.

Bruce Friedberg, MD, Staff Physician, Department of Emergency Medicine, Mount Diablo Medical Center
Bruce Friedberg, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Mainor Antillon, MD, Director, Pancreaticobiliary Endoscopy and Endosonography Program, Department of Internal Medicine, Division of Gastroenterology, King-Drew Medical Center; Associate Clinical Professor, Department of Medicine, University of California at Los Angeles
Disclosure: Nothing to disclose.

Thomas Tsou, MD, Director of Fast Tract and Pediatrics, Associate Professor, Departments of Medicine and Emergency Medicine, Charles R Drew University and University of California at Los Angeles
Thomas Tsou, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Jorge H Vargas, MD, Clinical Professor of Pediatrics, Division of Pediatric Gastroenterology, Hepatology & Nutrition
Jorge H Vargas, MD is a member of the following medical societies: American Liver Foundation, American Society for Gastrointestinal Endoscopy, American Society for Parenteral and Enteral Nutrition, Latin American Society of Pediatric Gastroenterology, Hepatology & Nutrition, and North American Society for Pediatric Gastroenterology and Nutrition
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

B U K Li, MD, Professor of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Director, Pediatric Fellowships and Gastroenterology Fellowship, Medical Director, Functional Gastrointestinal Disorders and Cyclic Vomiting Program, Medical College of Wisconsin; Attending Gastroenterologist, Children's Hospital of Wisconsin
B U K Li, MD is a member of the following medical societies: Alpha Omega Alpha, American Gastroenterological Association, and North American Society for Pediatric Gastroenterology and Nutrition
Disclosure: Nothing to disclose.

CME Editor

Steven M Schwarz, MD, FAAP, FACN, AGAF, Professor of Pediatrics, State University of New York, Downstate Medical Center College of Medicine; Distinguished Lecturer, New York Medical College, School of Public Health
Steven M Schwarz, MD, FAAP, FACN, AGAF is a member of the following medical societies: American Academy of Pediatrics, American College of Nutrition, American College of Physician Executives, American Gastroenterological Association, American Pediatric Society, Gastroenterology Research Group, New York Academy of Medicine, North American Society for Pediatric Gastroenterology and Nutrition, and Society for Pediatric Research
Disclosure: TAP Pharmaceuticals Honoraria Speaking and teaching; Curemark, LLC Consulting fee Board membership

Chief Editor

Carmen Cuffari, MD, Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine
Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

 
 
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