JAMA PATIENT PAGE Small Bowel Obstruction

A small bowel obstruction is a blockage in the small intestine. Small bowel obstructions are usually caused by scar tissue, hernia, or Treatment of Small Bowel Obstruction cancer.IntheUnitedStates,mostobstructionsoccurasaresultofprior A small bowel obstruction is a blockage in the small bowel surgeries. The bowel often forms bands of scar (called adhesions)af- that prevents normal flow of contents through the digestive tract. ter being handled during an operation. The more surgeries that in- A nasogastric tube (NG tube) is used to volve the bowel, the more scars are likely to form. If the bowel be- drain fluid from the stomach, so that the bowel can rest and return to normal size. comes trapped in adhesions, it may lead to a small bowel obstruction. In severe cases, the blood supply might be compromised, and the DILATED SMALL BOWEL bowel tissues might die. This is a life-threatening situation. NG tube

Symptoms NG tube drainage The small bowel constantly moves digested food and stomach juices Small bowel obstruction forward from the stomach to the colon. • A small bowel obstruction caused by adhesions may occur as early NORMAL SMALL BOWEL as a few weeks and as late as several years after a surgery without STOMACH any obvious inciting event. L A E L • An obstruction can cause the material inside the bowel to back up R G E B O W into the stomach. This causes nausea and vomiting of dark green During NG tube treatment, bile (bilious vomiting). patients receive intravenous • The bowel preceding the obstruction becomes large, dilated, and fluids for hydration. SMALL BOWEL filled with the fluid and air that would otherwise move forward. This causes bloating (abdominal distention). • When the bowel squeezes to push things forward past the ob- struction, it causes cramping and discomfort. ofthebowellooksunhealthyordead,itwillbecutoutandthehealthy • If fluid and air cannot advance beyond the obstruction, patients ends will be sewn back together. can no longer pass gas or have a bowel movement (obstipation). Any hernia can also entrap the bowel and cause similar symp- toms. A hernia can typically be detected during a doctor’s exami- Diagnosis and Treatment nation; in some cases imaging may be needed to ensure that a her- A history of surgeries, hernia, or cancer is important to know about. nia is not the cause of the obstruction. A doctor’s examination accompanied by blood tests and an x-ray or Warning Signs computed tomography (CT) scan can confirm the diagnosis. • Severe pain or fever may be a sign that the bowel is not receiving Most obstructions resolve by allowing the small bowel to rest enough blood or may be dead. and shrink back to its normal size, thus making the adhesions less • Patients without any history of bowel surgery or without a hernia problematic. This is accomplished by inserting a nasogastric (NG) found on examination should undergo a CT scan to exclude can- tube (a thin plastic tube that goes through a nostril and into the stom- cer as a possible cause of the obstruction. ach) that suctions fluid from the stomach. In addition, patients are not allowed to eat or drink during this time and are instead given in- travenous fluids for hydration. Usually,a small bowel obstruction re- FOR MORE INFORMATION solves after a few days. When a patient becomes less bloated, starts Mayo Clinic to pass gas, and has a bowel movement, the tube is removed and www.mayoclinic.org/diseases-conditions/intestinal-obstruction the patient is allowed to eat and drink. /symptoms-causes/syc-20351460 If the patient is not better, then operative intervention may be necessary.The surgery is called lysis of adhesions, which means cut- To find this and other JAMA Patient Pages, go to the For Patients collection at jamanetworkpatientpages.com. ting the scar tissue and freeing up the trapped bowel. If any part

Authors: Ioana Baiu, MD, MPH; Mary T. Hawn, MD, MPH The JAMA Patient Page is a public service of JAMA. The information and Conflict of Interest Disclosures: All authors have completed and submitted the recommendations appearing on this page are appropriate in most instances, but they ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page Sources: Greenfield LJ, Mulholland MW, Oldham KT,et al. Greenfield’s Surgery: Scientific may be photocopied noncommercially by physicians and other health care Principles and Practice. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006. professionals to share with patients. To purchase bulk reprints, call 312/464-0776. Schlicke C, Bargen A, Dixon C. The management of intestinal obstruction: an evaluation of conservative therapy. JAMA. 1940;115(17):1411-1416.

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