Small Bowel Obstruction

The most common cause here is Adhesions. Other causes include:

• Hernia

• Intussusception

• Gallstone

Patients typically present with:

• Abdominal pain – Initially colicky, then becomes continuous

• Abdominal distension

• Absolute constipation (no faeces or flatus)

• Bilious vomiting

O/E - Tympanic, high-pitched BS

Investigations

• A-E assessment

• Bloods - FBC, U&Es, Lactate, VBG

  • U&Es to check for any electrolyte imbalances

  • Lactate will be raised in bowel ischaemia

  • VBG will show metabolic alkalosis due to vomiting (loss of acid)

• AXR - Shows dilated bowel loops and valvulae conniventes (mucosal folds that form lines extending the full width of the bowel. On XR, it looks like coins stacked on top of one another.)

• Erect CXR - To check for pneumoperitoneum if suspected perforation

Management

Conservatively with NBM, Drip and Suck (IVF and NG aspirate for decompression), Anti-emetics

• Metoclopramide should be avoided here as it’s a prokinetic, therefore may worsen the obstruction and increase the risk of perforation

Surgery can be done if the conservative options fail.