Small Bowel Obstruction

Causes

A small bowel obstruction can be caused by something inside the body blocking the movement of contents of the intestine. Examples are:

• Scar tissue, such as from a prior surgery
• Intussusception —one part of the intestine slides up into another part of the intestine
• Volvulus—the intestine twists on itself
• Impacted foreign bodies—items that were swallowed and got stuck

It can also be caused by ileus. This is a slowing down or stopping of bowel activity. It is also called as pseudo-obstruction. It may be caused by surgery on the intestine or certain medicines, such as opioids.

Small Bowel Obstruction

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Risk Factors

Things that may raise the risk of a small bowel obstruction include:

• Hernias
• Crohn disease —an inflammatory bowel condition
• Abdominal, joint, or spine surgery
• Swallowing a foreign body
• A decrease in blood supply to the small bowel
• Abnormal growth of tissue in or next to the small intestine
• Tumors in the small intestine
• Cancer
• Infection in the lining of the small intestine
• Kidney disease
• Long-standing diabetes
• Gallstones (rare)

Symptoms

A person may have one or more of the following symptoms:

• Abdominal fullness and gas
• A swollen abdomen
• Pain and cramps in stomach area
• Vomiting
• Constipation
• Diarrhea
• Bad breath

Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done. The exam will include listening for bowel sounds in the stomach.

Pictures will be taken of the abdomen. This can be done with:

• CT scan
• MRI scan
• X-ray
• Ultrasound

Treatment

The goal of treatment will be to allow the contents of the intestine to move out of the body. How this is done depends on the cause and how severe it is.

Initial Care

Initial care and monitoring may used to see if the obstruction resolves on its own. This may include:

• Not eating anything by mouth
• IV fluids to promote hydration
• Nasogastric tube—A tube is inserted through the nose and into the stomach to remove fluids and gas
• Catheterization—A tube is placed in the bladder to drain and test urine

If the blockage is resolved, nutrition is given through an IV or feeding tube until the person can eat solid foods.

Medications

Medicines causing the obstruction may be stopped or changed. Other medicines may also be given, such as:

• Pain relievers
• Oral triple therapy—to reduce symptoms like gas and bloating
• Muscle stimulants—to promote muscle contractions in the intestine
• Antibiotics—to treat an infection if one is present

Surgery

Surgery may be needed to remove a blockage in people who are not helped by other methods. The surgery that is done will depend on the cause.

Prevention

There are no current guidelines to prevent small bowel obstruction.