Small Bowel Obstruction

Question 1

What is it?

Answer 1

Blockage caused by food, gallstones, tumour in wall, Crohn’s, radiation or due to adhesions or herniation outside wall

Question 2

How does it present?

Answer 2

Acute onset and presentation 
Vomiting 
Pain (colicky, central) 
Absolute constipation 
Burping 
Abdominal distension 
Dehydration 
Visible peristalsis 
May feel obstructing mass

Question 3

How is SB obstruction diagnosed?

Answer 3

Supine abdominal X-ray- confirm diagnosis, bowel proximal to obstruction is distended with gas
CT scan- help investigate and confirm

Question 4

What does the nature of vomit in a SBO tell us?

Answer 4

Level of obstruction

Question 5

What does semi-digested food eaten a day or 2 ago, no bile, tell us?

Answer 5

Gastric outlet obstruction

Question 6

What would copious, bile stained fluid suggest?

Answer 6

Upper SI obstruction

Question 7

What would thicker, brown, foul-smelling (faeculent) vomitus suggest?

Answer 7

Distal obstruction

Question 8

How is SBO treated?

Answer 8

Nil by mouth
Insert IV cannula ad send blood
Resuscitate with IV fluids
Pass a nasogastric tube to decompress stomach
Laparotomy: obstruction located by following collapsed or dilated bowel