What are the nonoperative treatments for small-bowel obstruction (SBO) and how does treatment vary based on the cause of the SBO?

Updated: Apr 28, 2017
  • Author: Mityanand Ramnarine, MD, FACEP; Chief Editor: Steven C Dronen, MD, FAAEM  more...
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Answer

Nonoperative treatment for several types of SBO are as follows:

  • Malignant tumor - Obstruction by tumor is usually caused by metastasis; initial treatment should be nonoperative (surgical resection is recommended when feasible)

  • Inflammatory bowel disease - To reduce the inflammatory process, treatment generally is nonoperative in combination with high-dose steroids; consider parenteral treatment for prolonged periods of bowel rest, and undertake surgical treatment, bowel resection, and/or stricturoplasty if nonoperative treatment fails.

  • Intra-abdominal abscess - CT scan ̶ guided drainage is usually sufficient to relieve obstruction

  • Radiation enteritis - If obstruction follows radiation therapy acutely, nonoperative treatment accompanied by steroids is usually sufficient; if the obstruction is a chronic sequela of radiation therapy, surgical treatment is indicated

  • Incarcerated hernia - Initially use manual reduction and observation; advise elective hernia repair as soon as possible after reduction

  • Acute postoperative obstruction - This is difficult to diagnose because symptoms are often attributed to incisional pain and postoperative ileus; treatment should be nonoperative

  • Adhesions - Decreasing intraoperative trauma to the peritoneal surfaces can prevent adhesion formation


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