Small bowel obstruction means the small intestine is partially or totally blocked. When this happens, the contents of the intestine cannot properly get out of the body. Stools, fluid, and gas build up inside the intestine. This is a potentially serious condition that requires urgent medical care.
Bowel obstruction may be caused by a mechanical problem. In this case, something inside the body blocks the movement of material through the intestine.
It can also be caused by an ileus, which is when the intestine itself does not work right. This nonmechanical type of obstruction is called
paralytic ileus, or
pseudo-obstruction. It is often the cause of obstruction in infants and children.
Mechanical small bowel obstruction may be caused by:
Adhesions—scar tissue left behind, in most cases by previous abdominal surgeryIntussusception—telescoping of the intestinal wallVolvulus—the intestine twists on itselfImpacted foreign bodies—items that were swallowed and got stuck
Paralytic ileus may be caused by surgery on the intestine or certain medications, such as opioids.
Small Bowel Obstruction
Copyright © Nucleus Medical Media, Inc.
Factors that may increase your chance of having a small bowel obstruction include: HerniasCrohn’s disease—an inflammatory bowel conditionAbdominal, joint, or spine surgerySwallowing a foreign bodyDecreased blood supply to the small bowelAbnormal growth of tissue in or next to the small intestineTumors in the small intestineCancerInfection in the lining of the small intestineKidney disease
Symptoms of small bowel obstruction often occur in combination. Small bowel obstruction may cause: Abdominal fullness and/or excessive gasDistension—abdomen feels stretched out more than normalPain and cramps in stomach areaVomitingConstipationDiarrheaBad breath
Paralytic ileus pain is often less severe than mechanical small bowel obstruction.
Your doctor will ask about your symptoms and medical history. A physical exam will be done. The exam will include listening for bowel sounds in your stomach. Very high pitched bowel sounds heard through a stethoscope suggest mechanical bowel obstruction. Conversely, paralytic ileus often produces no bowel sounds.
Imaging tests are used to evaluate abdominal structures. These may include: CT scanMRI scanX-rayUltrasound
Treatment depends on the cause and severity of the obstruction. You will usually require treatment by a specialist. Your doctor will also treat you for any underlying conditions that contribute to small bowel obstruction.
Before any surgical treatment or procedure can begin, you may need to be stabilized. This may include: Monitoring and IV fluids—At the hospital, doctors will watch closely to see if the blockage will get better on its own, which is often the case in the event of a paralytic ileus. No food will be allowed and fluids will be given through an IV.Nasogastric tube—A tube is inserted through the nose and into the stomach to remove fluids and gas, which can promptly relieve pain and pressure. It will be left in place until the intestines are working well.Catheterization—A tube is placed in the bladder to drain and test urine.
After the blockage is relieved, nutrition is administered through an IV or feeding tube until you are able to eat solid foods. Other treatment for small bowel obstruction includes:
Medications may include: Pain relieversOral triple therapy—to reduce gas, bloating, and improve symptomsMuscle stimulants—to promote muscle contraction in the intestineAntibiotics—to treat bacterial infections
Surgery may be needed if you do not respond to medical treatment, or in the following circumstances: Intestinal strangulation, which may be caused by volvulus or intussusceptionCancerAbdominal adhesionsHerniasPeritonitis
There are no current guidelines to prevent small bowel obstruction. Managing any underlying conditions, such as Crohn’s disease, can reduce your chances.
Abdominal adhesions. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at:
http://digestive.niddk.nih.gov/ddiseases/pubs/intestinaladhesions/index.aspx. Updated September 11, 2013. Accessed February 7, 2014.
Baron TH. Acute colonic obstruction. Gastrointest Endosc Clin N Am. 2007(17)2:323-329.
Bonin EA, Baron TH.
Update on the indications and use of colonic stents.
Curr Gastroenterol Rep. 2010;12(5):374-382.
Intestinal pseudo-obstruction. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at:
http://digestive.niddk.nih.gov/ddiseases/pubs/intestinalpo. Updated April 30, 2012. Accessed February 7, 2014.
Kulaylat MN, Doerr RJ. Small bowel obstruction. Available at: http://www.ncbi.nlm.nih.gov/books/NBK6873. Published 2001. Accessed February 7, 2014.
National Cancer Institute.
Gastrointestinal complications (PDQ): health professionals. National Cancer Institute website.
http://www.cancer.gov/cancertopics/pdq/supportivecare/gastrointestinalcomplications/healthprofessional. Updated September 10, 2013. Accessed February 7, 2014.
Small bowel obstruction. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed. Updated September 3, 2013. Accessed February 7, 2014.
4/7/2014 DynaMed's Systematic Literature Surveillance. http://www.ebscohost.com/dynamed: Katz DS, Baker ME, et al. Suspected small bowel obstruction. American College of Radiology (ACR) Appropriateness Criteria. Available at: http://www.acr.org/~/media/832F100277004BC69A8C818C7C9BFF33.pdf. Updated 2013.
Last reviewed February 2014 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © EBSCO Publishing. All rights reserved.