Small Bowel Obstruction (SBO)

A small bowel obstruction (SBO) is a serious condition where the small intestine becomes physically blocked, preventing food, fluids, and gas from passing through. This differs from an ileus, where the blockage is caused by a temporary disruption of the intestine's muscle function rather than a physical barrier. A small bowel obstruction can be a partial or complete blockage and is considered a medical emergency, especially if the blood supply to the intestine is compromised. 

Common causes

  • Adhesions (scar tissue): These are the most frequent cause of small bowel obstructions in developed countries. Adhesions are fibrous bands of tissue that form in the abdomen, most often after prior abdominal or pelvic surgery. They can twist or pull on the intestines, causing a blockage.

  • Hernias: An abdominal wall hernia occurs when a part of the intestine pushes through a weak spot in the abdominal wall. This can trap a loop of the small intestine, leading to an obstruction.

  • Tumors: Both cancerous and non-cancerous tumors within the small intestine can physically block the passageway. Tumors from other organs can also spread and cause an obstruction.

  • Crohn's disease: This inflammatory bowel disease can cause inflammation and thickening of the intestinal walls, which may result in a narrowed passageway (stricture).

  • Intussusception: This is a condition where one segment of the intestine telescopes into another. While more common in children, it can also cause an SBO in adults, often due to a growth or polyp.

  • Volvulus: This occurs when a segment of the intestine twists around itself, cutting off blood flow and causing a blockage. 

Signs and symptoms

The symptoms of a small bowel obstruction can develop gradually or suddenly, depending on whether the blockage is partial or complete.

  • Cramping abdominal pain: This pain often comes in intense waves and can be centered around the belly button. If the pain becomes constant and severe, it may signal a life-threatening complication called strangulation, where the blood supply is cut off.

  • Nausea and vomiting: Vomiting is common as intestinal contents back up. The vomit may appear greenish (bilious) from bile.

  • Abdominal bloating: The abdomen can swell and feel tight as gas and fluids accumulate above the blockage.

  • Changes in bowel movements: Patients may experience constipation or an inability to pass gas. In cases of a partial blockage, they might have some diarrhea as fluid and gas leak around the obstruction.

  • Loss of appetite: You may feel full and have little desire to eat. 

Diagnosis

A doctor will use several methods to confirm a small bowel obstruction and rule out other conditions.

  • Physical exam: The doctor will check for abdominal swelling, tenderness, and listen for bowel sounds. In early SBO, bowel sounds may be high-pitched, while in later stages or with a complete blockage, they may be faint or absent.

  • Imaging tests:

    • X-rays: Plain abdominal X-rays can show dilated loops of small bowel and air-fluid levels.

    • CT scan: A computed tomography (CT) scan is the gold standard for diagnosing a small bowel obstruction. It provides a detailed cross-sectional view that can help pinpoint the blockage's location and cause.

  • Blood tests: Blood work can reveal electrolyte imbalances or signs of infection, which can occur with vomiting or a severe obstruction. 

Treatment

Treatment for a small bowel obstruction depends on its cause and severity.

  • Hospitalization and stabilization: Patients are admitted to the hospital, where they are given IV fluids to prevent dehydration and correct electrolyte imbalances.

  • Bowel rest: Doctors will have you stop eating and drinking to give the bowel a rest.

  • Nasogastric (NG) tube: A tube is passed through the nose and into the stomach to suction out backed-up air and fluid, which helps relieve pain, distension and pressure.

  • Medication management: Pain relievers and anti-nausea medications are used for symptom control.

  • Surgery: If the obstruction is complete, does not improve with non-surgical treatment, or if the blood supply is compromised (strangulated), surgery is required. The surgeon will remove the blockage and any damaged sections of the intestine. In some cases, a surgeon can place a wire mesh tube (stent) to open the intestine without major surgery. 

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