A small bowel obstruction (SBO) occurs when the small intestine becomes blocked, preventing the contents of the intestines from passing normally. This can lead to severe pain, nausea, vomiting, and an inability to pass gas or have a bowel movement. While surgery is often required to fix a complete SBO, there are some cases where non-surgical treatment may be attempted first. This article will discuss the causes, diagnosis, and non-surgical treatment options for a small bowel obstruction.
What causes a small bowel obstruction?
There are several potential causes of a small bowel obstruction:
- Adhesions – Scar tissue (adhesions) from previous abdominal or pelvic surgery can wrap around the intestine and squeeze it closed. This is the most common cause of SBOs.
- Hernias – Portions of the intestine can sometimes poke throughweak areas in the abdominal wall, forming a loop that gets trapped and obstructed. This is called a hernia.
- Inflammation – Ongoing inflammation from conditions like Crohn’s diseaseor diverticulitis can thicken intestinal walls and narrow the bowel channel.
- Tumors – Cancerous tumors in the abdomen may press on and obstruct sections of bowel.
- Intussusception – One portion of intestine collapses or telescopes into the next segment, pinching it off.
- Foreign bodies – Objects accidentally swallowed can become lodged in the intestines.
In many cases, the exact cause of the obstruction cannot be identified. SBOs that arise without any clear underlying condition are termed idiopathic.
What are the symptoms of a small bowel obstruction?
Symptoms of an SBO may include:
- Cramping abdominal pain that comes and goes
- Distended, swollen abdomen
- Nausea and vomiting, sometimes vomiting green or brown material
- Inability to pass gas or have a bowel movement
- Feeling constipated
As the obstruction gets worse, symptoms can become more severe and include:
- Profound nausea, vomiting, and abdominal pain
- High fever
- Rapid heart rate
- Shortness of breath
- Confusion
These symptoms indicate a complete intestinal blockage and requires emergency medical care.
How is a small bowel obstruction diagnosed?
To diagnose an SBO, doctors will perform:
- Physical exam – Pressing on the abdomen to feel for swelling, tenderness
- Medical history – Discussing any prior surgeries, abdominal diseases
- Blood tests – Checking for signs of dehydration or infection
- X-ray – Looking for dilated loops of bowel, air-fluid levels
- CT scan – Provides more detailed images to locate obstruction
Often, the x-ray or CT scan can pinpoint the location and cause of the blockage. However, the diagnosis cannot be confirmed until the obstruction is directly seen during surgery or endoscopy.
Can a small bowel obstruction clear on its own?
In some cases, a partial SBO may resolve spontaneously without surgery. This occurs if the source of obstruction is temporary, such as severe constipation or a twisting of the intestines. Vomiting and fluids can back up behind the blockage and eventually push it through, clearing the passageway.
Passage of the obstruction usually leads to a sudden improvement in symptoms. Doctors may try to facilitate this process through:
- Nasogastric tube – Inserted through the nose down into the stomach to suction out fluids and decompresses the intestines. This takes some pressure off the obstruction.
- Laxatives/enemas – Help push stool through to clear potential impactions.
- Pain medications – Reduce intestinal spasms that may be complicating obstruction.
- IV fluids – Rehydrates the body and corrects electrolyte imbalances.
However, a complete SBO will not resolve on its own. The blockage must be removed either endoscopically or through surgery.
When is emergency surgery required for a small bowel obstruction?
Surgery is urgently needed if the small bowel obstruction is:
- Complete vs. partial – Complete blockage prevents any intestinal contents from getting through, while partial allows some liquid stool to leak across.
- Strangulated – Obstructed loop is tightly twisted or pinched, cutting off blood supply. This can cause infection and tissue death within hours.
- Ischemic – Lack of blood supply causes ischemic bowel that may perforate.
- Leads to perforation – Hole forms in weakened intestinal wall that can leak bowel contents.
Surgery is also required if non-surgical management does not provide improvement within 48-72 hours. Worsening pain, vomiting, fever are signs that the obstruction persists and abdomen needs to be explored surgically. Delaying necessary surgery raises the risk of sepsis and bowel perforation.
What types of surgery fix a small bowel obstruction?
There are several surgical procedures to relieve an SBO:
- Small bowel resection – Removing irreversibly damaged section of intestine and reconnecting healthy ends.
- Adhesiolysis – Cutting away internal scar tissue causing kinks or traction.
- Hernia repair – Pushing herniated section of bowel back into abdomen and strengthening muscle defects.
- Obstruction extraction – Removing lodged foreign body or food bolus.
- Bypass – Going around obstructed segment by joining small bowel above and below.
In cases of bowel necrosis, multiple segments may need removal with more extensive resection and anastomosis. Temporary ileostomy diversion of stool may be required to allow downstream healing.
What are possible complications following small bowel obstruction surgery?
Complications may include:
- Bleeding
- Infection
- Wound dehiscence
- Anastomotic leak
- Fistula formation
- Blood clots
- Bowel perforation
- Sepsis
- Incisional hernia
- Recurrent bowel obstruction
Recovering intestinal function and preventing repeat SBOs relies on early mobilization, proper nutrition, and cautious advance of diet post-operatively.
What are non-surgical treatments for small bowel obstructions?
For partial SBOs that may still resolve without surgery, conservative management options include:
Nasogastric tube insertion
A plastic tube inserted through the nose, down the esophagus into the stomach allows constant suctioning of GI secretions. This decompresses the bowel, improving the obstruction.
Fluid resuscitation
IV fluids are given to correct dehydration and electrolyte disturbances. Hydration also improves the obstruction by softening stool contents. Electrolytes like potassium are replaced.
Nutrition support
Once vomiting improves, a liquid diet can be started, followed by advancement as tolerated. Parenteral nutrition is given intravenously if unable to take sufficient PO nutrition.
Medications
Antiemetic and antispasmodic agents relieve nausea and reduce intestinal cramping. Antibiotics treat or prevent infection.
Bowel rest
No food or liquids by mouth allows the GI tract to rest while the suction tube decreases fluid accumulation. Helps decompress intestine.
Manual disimpaction
The doctor may massage the abdomen or perform rectal maneuvers to try mobilizing stool stuck at the site of obstruction.
When will the bowel obstruction likely recur after non-surgical treatment?
Recurrence risk depends on the cause of the initial SBO:
- Adhesions – Very high recurrence rate without surgery to lyse bands
- Hernias – Moderate recurrence unless hernia is corrected
- Cancers – High recurrence if tumor not removed
- Inflammation – Variable depending on disease course
- Intussusception – Lower recurrence once lead point resolved
- Foreign bodies – Recurrence unlikely unless behavior repeats
Partial SBOs have a higher overall recurrence rate than complete obstructions. Repeated episodes also increase recurrence likelihood. Strict prevention of constipation and early surgery for second obstructions may prevent recurrences.
What home remedies help relieve symptoms of a partial small bowel obstruction?
Home remedies to try for mild, partial SBO symptoms include:
Clear liquids
Water, juices, broths, popsicles, and gelatin provide hydration without stimulating gut. Avoid milk, which can cause cramping.
Warm compress
Heating pads or hot water bottles applied to the abdomen can provide soothing relief from cramping.
Peppermint tea
Has antispasmodic effects on the intestines and may calm cramping and bloating. Avoid in reflux or heartburn.
Coffee
The caffeine induces intestinal contractions to propel stool. Can stimulate laxative effect.
Probiotics
Promotes healthy gut bacteria balance. Can help regulate bowel patterns long-term.
Abdominal massage
Gentle clockwise strokes over the abdomen may relax intestinal muscle.
However, these will not cure a true mechanical obstruction – only surgery can definitively repair this. Worsening symptoms should prompt urgent medical evaluation.
What foods should you avoid during a small bowel obstruction?
A low residue, easy to digest diet is recommended during partial SBOs while trying to manage them non-operatively. Restrict:
- Fibrous fruits and vegetables – celery, berries, broccoli
- Whole grains – oats, bran, quinoa
- Dried fruits and nuts
- Fatty, greasy foods
- Gas producing foods – beans, onions, cabbage
For complete bowel obstruction, a nil per os (NPO) diet is ordered until the obstruction is relieved. Intake by mouth increases fluid secretion and gas buildup.
What are warning signs that a small bowel obstruction is getting worse?
Seek emergency care if you develop:
- Increasing pain severity
- Constant vomiting without relief
- High fever, chills
- Abdominal swelling and tenderness
- Inability to pass any stool or gas
- Lightheadedness, confusion
- Coffee ground appearing vomit
- Black, tarry stools
These red flag symptoms indicate the bowel obstruction is progressing or complications are arising, like perforation, sepsis, or ischemia. Urgent surgical intervention may be needed.
When to consider surgery for a chronic small bowel obstruction?
Surgery may be recommended after:
- 3 or more obstructions within a few months
- Hospitalization for more than 10 days without resolution
- Unable to re-establish oral nutrition
- Continued severe pain
- Significant bowel dysfunction afterwards
- Failure to thrive – losing weight, muscle wasting
Earlier surgery prevents worsening nutritional deficit and allows more bowel-sparing options. Laparoscopy is less invasive and reduces adhesion formation. Open surgery is required if the abdomen is too inflamed.
Conclusion
Mild, partial small bowel obstructions may resolve with non-surgical management, including bowel rest, fluid resuscitation, tube decompression, and medications. However, complete SBO requires urgent surgery to prevent catastrophic complications. Certain symptoms and recurrent SBOs warrant earlier surgical intervention. While adhesions are a common cause, the underlying etiology guiding treatment includes hernias, inflammation, and tumors. Regardless of approach,监测 hydration, nutrition, pain control and any symptom progression is key.