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A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction

  • Small Intestine (D Sachar, Section Editor)
  • Published:
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Abstract

Purpose of Review

This study aimed to systematically review small bowel obstruction (SBO), focusing on recent changes in diagnosis/therapy.

Recent Findings

SBO incidence is about 350,000/annum in the USA. Etiologies include adhesions (65%), hernias (10%), neoplasms (5%), Crohn’s disease (5%), and other (15%). Bowel dilatation occurs proximal to obstruction primarily from swallowed air and secondarily from intraluminal fluid accumulation. Dilatation increases mural tension, decreases mucosal perfusion, causes bacterial proliferation, and decreases mural tensile strength that increases bowel perforation risks. Classical clinical tetrad is abdominal pain, nausea and emesis, abdominal distention, and constipation-to-obstipation. Physical exam may reveal restlessness, acute illness, and signs of dehydration and sepsis, including tachycardia, pyrexia, dry mucous membranes, hypotension/orthostasis, abdominal distention, and hypoactive bowel sounds. Severe direct tenderness, involuntary guarding, abdominal rigidity, and rebound tenderness suggest advanced SBO, as do marked leukocytosis, neutrophilia, bandemia, and lactic acidosis. Differential diagnosis includes postoperative ileus, narcotic bowel, colonic pseudo-obstruction, mesenteric ischemia, and large bowel obstruction. Medical resuscitation includes intravenous hydration, correcting electrolyte abnormalities, intravenous antibiotics, nil per os, and nasoenteral suction. Abdominal CT with oral and intravenous gastrografin contrast is highly sensitive and specific in detecting/characterizing SBO. SBO usually resolves with medical therapy but requires surgery, preferentially by laparoscopy, for unremitting total obstruction, bowel perforation, severe ischemia, or clinical deterioration with medical therapy. Overall mortality is 10% but increases to 30% with bowel necrosis/perforation.

Summary

Key point in SBO is early diagnosis, emphasizing abdominal CT; aggressive medical therapy including rehydration, antibiotics, and nil per os; and surgery for failed medical therapy.

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  1. Division of Gastroenterology and Hepatology, Department of Medicine, William Beaumont Hospital, 3535 West Thirteen Mile Road, Royal Oak, MI, 48073, USA

    Srinivas R. Rami Reddy & Mitchell S. Cappell

  2. Oakland University William Beaumont School of Medicine, Royal Oak, MI, 48073, USA

    Mitchell S. Cappell

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Mitchell Cappell reports personal fees as a consultant to the United States Food & Drug Administration (FDA) Advisory Committee for Gastrointestinal Drugs but affirms that this paper does not discuss any proprietary, confidential, and pharmaceutical data submitted to the FDA and reports personal fees as a member of the speaker’s bureau for AstraZeneca and Daiichi Sankyo, co-marketers of Movantik. This work does not discuss any drug manufactured or marketed by AstraZeneca or Daiichi Sankyo. Srinivas Reddy declares no conflict of interest.

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This article is part of the Topical Collection on Small Intestine

Drs. Reddy and Cappell are equal primary authors.

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Rami Reddy, S.R., Cappell, M.S. A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction. Curr Gastroenterol Rep 19, 28 (2017). https://doi.org/10.1007/s11894-017-0566-9

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