Synopsis
Recognise small-bowel obstruction and strangulation, resuscitate while defining cause and transition on contrast CT, and select non-operative management only when a safe monitored adhesional pathway is appropriate with immediate senior surgical, radiology and local contrast-protocol input.
- Small-bowel obstruction presents with colicky pain, vomiting, distension and obstipation, but diarrhoea or stool passage can continue early or in partial obstruction.
- Adhesions are common after surgery, but always examine hernial orifices and consider tumour, Crohn's stricture, volvulus, intussusception, gallstone ileus and radiation disease.
- Continuous pain, fever, tachycardia, peritonism, acidosis or CT reduced enhancement, closed loop, mesenteric oedema, pneumatosis or free fluid raises strangulation and requires urgent operation.
Key red flags
Pain becomes continuous, localised or disproportionate, with tachycardia, fever, guarding, acidosis, shock or free air. This requires immediate senior surgical and theatre planning.
Investigation priorities
Confirm mechanical obstruction, level and cause, identify closed loop, hernia, tumour, inflammatory disease and signs of ischaemia or perforation.
Management branches
A mechanical small-bowel obstruction is clinically suspected.
- Use ABCDE, provide analgesia and antiemetic, keep nil by mouth, gain intravenous access and correct fluid and electrolyte loss with urine monitoring.
- Place a nasogastric tube for significant vomiting, proximal dilatation or aspiration risk according to the surgical plan, confirming position before use.
Key medicines
Balanced intravenous crystalloidGive an initial resuscitation bolus and subsequent replacement guided by physiology, urine, nasogastric loss and NICE CG174; add electrolytes from measured deficits.
Broad-spectrum perioperative antibioticUse the current local intra-abdominal sepsis regimen when strangulation, perforation, surgery or systemic infection is suspected, with renal adjustment.