Small Bowel Obstruction

Abstract

Small bowel obstruction (SBO) is a common clinical condition characterized by symptoms of intermittent abdominal pain, nausea, vomiting, obstipation, fever, and tachycardia. Small bowel obstruction accounts for 20 % of all surgical admissions for acute abdomens (Foster et al., J Am Coll Surg 203:170–6, 2006). Late, misdiagnosis, or even appropriate management of small bowel obstruction has been a source of frustration for many practicing general surgeons at some time during their surgical careers. Because of the acute onset of SBO, the majority of patients present in the emergency room (ER). Therefore patient evaluation, decision-making, subsequent operations, and non-operative management are often performed by the “surgeon on call.” With the new paradigm shift regarding the management of surgical emergencies, the majority of patients with SBO are now being managed successfully by the acute care surgeon. The acute care surgeon is accustomed to dealing with difficult cases, and operating on a patient with SBO is often a complicated procedure. There are multiple issues to address when operating on patients with SBO including entering hostile abdomens, enterostomies, fistulas, wound infections, short bowel issues, and recurrent obstructions, just to name a few. The traditional surgical dictum “the sun should never rise and set on a small bowel obstruction” is no longer considered an entirely valid statement. This caveat may be attributed in part to the surgeon’s improved diagnostic ability to differentiate complete obstruction, which could compromise intestinal viability, from a partial obstruction, which is amenable to non-operative management. Thus in the absence of signs suggesting strangulation, a patient with partial obstruction can be treated and managed effectively using non-operative modalities. Nevertheless, patients with SBO who have been managed surgically have better outcomes and lower healthcare costs compared to those managed non-operatively.