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Bowel Obstruction (Small and Large), Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Obstruction of normal intestinal flow from mechanical or nonmechanical causes

  • Small-bowel obstruction (SBO):

    • 20% of acute surgical admissions

    • Adhesions: Most common cause (60%)

    • Neoplasms

    • ...

Diagnosis

Signs and Symptoms

History

  • Previous surgery, malignancy, hernias, colonoscopy history, significant family history

  • Abdominal pain:

    • Intermittent when early

    • Symptoms may be vague in elderly or alter...

Treatment

Pre-Hospital

Establish IV access for patients with dehydration, vomiting, or significant abdominal pain. 

Initial Stabilization/Therapy

  • ABCs

  • 0.9% normal saline (NS) or lactated ringers (LR) IV f...

Follow-Up

Disposition

Admission Criteria

All patients with suspected/confirmed intestinal obstruction should be admitted with early surgical consultation. 

Discharge Criteria

Normal lab/radiology results ...

Pearls and Pitfalls

  • Carefully examine patient with history of vomiting for incarcerated hernias.

  • Failure to diagnose strangulated bowel obstruction:

    • Symptoms potentially vague in very old and very young...

Additional Reading

  • Batke  M. Cappell  MS. Adynamic ileus and acute colonic pseudo-obstruction. Med Clin North Am.  2008;92(3):649–670.

  • Diaz  JJ Jr, Bokhari  F, Mowery  NT, et al. Guidelines for ma...

Codes

ICD9

  • 560.9 Unspecified intestinal obstruction

  • 560.81 Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection)

  • 560.89 Other specified intestinal obstruction

  • 560.1 Paralytic...

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