What happens in the hospital?
The medical team will ask about symptoms, how long it has been happening for, and prior operations and conduct a physical examination, focusing on the abdomen. They will also get blood tests to check for signs of infection and dehydration. The medical team will also likely get some images, including X-rays or a computerized set of X-rays known as a CT scan to help diagnose the presence and location of the blockage (figure 1).
Radiographic image of a small bowel obstruction showing dilated (bloated) intestines filled with air (darker areas represent air within the intestines).
Medical (non-surgical) options
In most cases, SBO is treated without surgery, where the blockage clears within days with ‘bowel rest’. Resting the bowels involves not letting the patient eat anything and giving fluids intravenously to prevent and treat dehydration. A nasogastric (NG) tube may be placed through the nose and goes down the esophagus or food tube into the stomach. This NG tube is connected to a machine that sucks up the backed-up fluids in the stomach, with a goal of relieving nausea and abdominal pressure.
The medical team may also put liquid dye (called ‘contrast’) into the tube to help visualize the blockage on X-rays or CT scans. In some cases, the contrast may even help fix the blockage.
Surgical options
Surgery for SBO may be needed if the non-surgical treatment has not worked within a few days or if there is worry that the bowel is dying from lack of blood flow based on physical examination changes, blood tests or imaging.
Abdominal surgery is either ‘open’, with a larger cut down the middle of the abdomen, called a laparotomy, or with a ‘minimally invasive approach’ (laparoscopic or robotic). The minimally invasive approach is done by making a few smaller cuts on the abdomen and placing a camera and small tools through the cuts to fix the problem. The method of surgery will depend on many patient factors and surgeon preference, but surgery for SBO is more commonly an open operation.
During SBO surgery, the surgeon will examine the intestines and find the blockage. Sometimes, only untwisting the intestines or removing scar tissue is needed to fix the blockage (figure 2). Other times, especially if part of the intestine is not healthy, the surgeon may need to remove a part of the intestine and then put the intestines back together, called a small bowel resection and anastomosis. Patients with prior health issues, such as diabetes or tobacco use, are more likely to become sicker with surgery. This can lead to the surgeon deciding to leave the abdomen open with plans to go back to the operating room in 1 day to2 days.
Illustration of a small bowel obstruction caused by scar tissue (illustration by Charlotte Smith).
Care after treatment
Most patients need care on a surgical floor of the hospital after surgery, but some may need to go to the intensive care unit. Whether the obstruction was fixed with surgery or not, patients stay in the hospital until the intestines are working normally again, which usually takes between 1 day and a week. This is decided by seeing if the patient can pass gas or has a bowel movement, how bad their abdominal pain is, and if they can eat food without having nausea or vomiting. Some patients start on a liquid-only diet and then progress to a solid diet over time. Most patients are sent home within a day of being able to eat food. Patients are asked to walk a lot to help stop blood clots from being made in their legs.
Possible complications
Dehydration and malnutrition may occur after having an SBO, as sometimes it can take a while for a normal appetite to return. Patients may get an ileus, which is when the intestines are slow to come back to normal function after surgery. All surgical patients are at risk of developing an infection at the surgical wounds on their skin or within their abdomen. Complications such as pneumonia, urine infection and blood clots may also occur for any patient hospitalized for a surgical problem, but they are more common in sicker patients.
