Small Bowel Obstruction

Small bowel obstruction usually occurs as a result of some mechanical factor and should be differentiated from a paralytic ileus where the small bowel dilates due to a loss of peristalsis (contraction) secondary to sepsis or metabolic derangement. This may cause a buildup of fluid and gases in the portion above the blockage, which may cause abdominal pain, nausea or vomiting and subsequently interfere with the absorption of fluids, causing dehydration and acidosis.

The following are some of the most common causes of small bowel obstruction:

• Bands:
  if a patient has had previous surgery, the chances are very good that some intra-abdominal bands will have formed. Mostly they remain asymptomatic but occasionally may result in small bowel obstruction.
• Hernias:
  small bowel can become trapped in a hernia (incarcerated) and lead to small bowel obstruction. Mostly the patient will be aware of the hernia, i.e. a pre-existing inguinal hernia and the incarceration will be quite obvious. Occasionally the hernia can be occult, and the reason for the obstruction will be more difficult to diagnose.
• Tumours:
  although rare, any growth of the small bowel, whether benign or malignant can cause small bowel obstruction. They may originate from the small bowel itself or manifest as spread from other cancers such as melanoma. Fortunately, tumours of the small bowel are very rare.
• Gallstones:
  occasionally a very large gallstone can erode into the small bowel and cause small bowel obstruction, usually in the most distal (and most narrow) part of the small bowel.

What are the related symptoms of small bowel obstruction?

You may experience a combination of some or all of the following symptoms:

• Colicky abdominal pain
• Nausea and vomiting
• Abdominal distension
• Constipation (not passing stools)
• Obstipation (not passing stools or gas)
• Fever/sepsis (in longstanding cases bacteria can translocate from the gut to the bloodstream)
• Dehydration
• Loss of appetite
• Bloating

How is small bowel obstruction treated?

Treatment depends on the suspected underlying cause of the obstruction. When bands are suspected and you are otherwise stable, a period of conservative management might be undertaken. For all other cases, Dr Cooper will recommend surgery in order to confirm the diagnosis, relieve the obstruction and restore intestinal continuity. Surgery can either be open (laparotomy) or minimally invasive (laparoscopy).