Mechanical or functional blockage of bowel transit; classified SBO vs LBO.
Causes
- • SBO: adhesions, hernia, malignancy, Crohn's
- • LBO: malignancy, volvulus, diverticular stricture
Clinical features
- • Colicky abdominal pain
- • Vomiting (early SBO, late LBO)
- • Absolute constipation
- • Distension
Examination
- • Distension, tinkling/absent bowel sounds
- • Tenderness
- • Hernial orifices
- • PR for impaction / mass
Investigations
- • FBC, U&E, lactate (ischaemia)
- • Erect CXR (free gas)
- • AXR (dilated loops, valvulae conniventes vs haustra)
- • CT abdo (transition point, cause, ischaemia)
Management
- • Drip and suck: IV fluids, NG decompression
- • Catheterise, analgesia, antiemetic
- • Conservative trial in adhesional SBO 24–48 h
- • Surgery for strangulation, closed-loop, failure, LBO from malignancy / volvulus
Complications
- • Strangulation, perforation
- • Sepsis, AKI
- • Aspiration
Clinical pearls
- • Closed-loop obstruction needs urgent surgery
- • Sigmoid volvulus: coffee-bean sign, attempt flatus tube decompression
Related in WardRound
Educational — verify locally.
