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Small Bowel Obstruction
Last updated 14th May 2021
- More common than large bowel obstruction
- Common causes – adhesive obstruction, malignancy (peritoneal deposits and extrinsic compression), hernias, volvulus and Crohn’s disease
- Uncommon cause – Gallstones.
Presentation
- Abdominal pain, usually colicky in nature
- Nausea & vomiting – bilious vomiting for high obstruction and faecal vomiting for lower obstruction
- Tympanic bowel sounds
Investigations
- Bloods – FBC, U&E, LFT, CRP
- VBG – hypochloraemic metabolic alkalosis secondary to vomiting
- Erect CXR + AXR
>3cm indicates small bowel obstruction
Valvulae conniventes/ plicae circularis seen
No gas in large colon - CT Abdo/Pelvis scan
Management
- NBM
- Drip and suck – IV Fluids (Replace losses + maintenance fluids) + wide bore NG tube on free drainage and frequent aspiration
- Catheter
- Adhesive obstruction is usually managed conservatively, primary causes of obstruction need operative intervention