Key Points
- Use the highest‑yield diagnostic test early; do not let testing delay time‑critical therapy.
- Set objective targets (hemodynamic, neurologic, respiratory) and reassess frequently.
- Plan definitive source control or immunomodulation when indicated; document follow‑up and patient education.
Algorithm
- Resuscitate; NG decompression; NPO; correct electrolytes.
- CT to confirm level/cause and assess for closed loop/ischemia.
- Give water‑soluble contrast; observe for transit to colon within 24 h.
- Urgent surgery if peritonitis, ischemia, closed loop, or failure of non‑operative management within 48–72 h.
Clinical Synopsis & Reasoning
Common post‑operative SBO managed initially with fluid resuscitation, NG decompression, and water‑soluble contrast challenge. Operate urgently for peritonitis, strangulation, or failure of non‑operative management.
Treatment Strategy & Disposition
Stabilize ABCs. Initiate guideline‑concordant first‑line therapy with precise dosing and continuous monitoring. Escalate to advanced or procedural interventions based on explicit failure criteria. Define ICU, step‑down, and ward disposition triggers; involve specialty teams early.
Epidemiology / Risk Factors
- Risk varies by comorbidity and precipitants; see citations for condition‑specific data.
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|---|---|---|
| CT abdomen/pelvis with contrast | Diagnosis/severity | Transition point, closed loop, ischemia signs | Guide operative decision |
| Lactate/WBC | Strangulation risk | Elevated suggests ischemia | Trend with exam |
| Water‑soluble contrast study | Therapeutic/prognostic | Transit to colon within 24 h predicts success | May reduce OR need |
Pharmacology
| Medication/Intervention | Mechanism | Onset | Role in Therapy | Limitations |
|---|---|---|---|---|
| Isotonic fluids | Resuscitation | Immediate | Correct dehydration/AKI risk | Monitor electrolytes |
| NG tube decompression | Mechanical | Immediate | Symptom relief; nausea/vomiting control | Aspiration prevention |
| Analgesia/antiemetics | Supportive | Minutes | Symptom control | Avoid ileus‑worsening opioids when possible |
Prognosis / Complications
- Outcome depends on timeliness of diagnosis and definitive therapy; monitor for complications.
Patient Education / Counseling
- Provide red‑flag education, adherence guidance, and explicit return precautions; arrange timely specialty follow‑up.
References
- WSES/Bologna Guidelines for Adhesive Small Bowel Obstruction (2018) — Link