Management of Small Bowel Obstruction
A small bowel obstruction is a blockage of the small bowel that prevents enteric contents from progressing to the colon for elimination. Patients experience abdominal pain, usually with nausea and vomiting. Often patients notice no or several diminished gas and a lack of bowel movements. There are three explanations for small bowel obstructions- internal causes, external causes, and metabolic causes. Internal causes of small bowel obstructions include intestinal masses, food or hair blocking the lumen of the intestine, and a gallstone blocking the intestinal lumen. This last example is referred to as a “gallstone ileus”. External causes include an abscess or other abdominal mass compressing the bowel and decreasing the size of the lumen. Most commonly, patients develop scar tissue after surgery or adhesions, which narrow the bowel lumen. Lastly, metabolic causes such as electrolyte abnormalities or opiate use can cause an ileus, which is often mistaken for an obstruction. An ileus refers to poorly functioning bowel that is unable to perform normal peristalsis.
The management of small bowel obstruction can vary depending on the age and cause of the obstruction. The first step always involves a history and physical examination to help determine the cause of the obstruction or ileus. An x-ray and often a computed topography (ct) scan is used to determine the site of the obstruction. A ct scan with oral contrast will not only identify the site of obstruction but will often act as treatment as well. The oral contrast acts to draw more water into the bowel and resolve any constipation. Patients are asked to refrain from any oral intake to prevent further bowel distension. IV fluids are given and a nasogastric tube is placed to deflate any dilated loops of bowel that may kink off and cause an obstruction. Small bowel obstructions due to adhesions often resolve with non-operative treatment. However, if symptoms persist or the patient decompensates surgery is necessary to remove the offending scar tissue or resect the area of concern. Recovery time will depend on the type of surgery performed and overall patient health.
When patients are looking for a surgeon to help with the management of small bowel obstruction, it is important that they find a board-certified surgeon because this indicates a certain level of expertise in the field. Dr. Jenna Kazil is an astonishing double board-certified general and vascular surgeon who practices at various hospitals in Manatee, Hillsborough, and Osceola counties. Over the years, Dr. Kazil has developed a reputation for handling a wide range of vascular and general surgical procedures with the precision that every patient deserves. People living on Florida’s West coast from Pinellas Park to Sarasota looking for a spectacular surgical specialist should contact the Florida Surgical Clinic today to schedule an appointment with a vascular and general surgeon.