What is the role of nonoperative treatment in the management of small-bowel obstruction (SBO)?

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

A nonoperative trial of as many as 3 days is warranted for partial or simple obstruction. Provide adequate fluid resuscitation and NG suctioning. Resolution of obstruction occurs in virtually all patients with these lesions within 72 hours. Good data regarding nonoperative management suggest it to be successful in 65-81% of partial SBO cases without peritonitis. [10, 13] 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 often are 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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