Small Bowel Obstruction (SBO): Management

00:02 What do we wanna do for these patients? So we’ve gotten our diagnosis.

00:05 We’ve asked all the appropriate questions for the patient.

00:07 We wanna start out by giving IV fluids.

00:11 So IV fluids are gonna help rehydrate a patient.

00:13 Oftentimes, these patients when they come in have a lot of nausea and vomiting.

00:18 So IV fluids are gonna help resuscitate them.

00:21 They’re gonna hopefully help get them feeling better.

00:23 Anti-emetics can also be very, very helpful.

00:26 They can help with the vomiting.

00:28 They can help hopefully slow some of that down.

00:32 NG or nasogastric tube placement is a little bit debatable.

00:36 There is little evidence that says that it definitely helps a lot with patients but sometimes the surgery team will request it.

00:43 You wanna think about doing this for patients with altered mental status who are at risk for aspiration.

00:48 It’s not without risk and it can be a painful procedure for patients.

00:52 So we wanna make sure that we’re selecting the right patient population to perform this in.

00:57 NG tubes can potentially go in the lungs, they can increase risk for aspiration in certain patients, and again, it’s a very uncomfortable procedure for patients.

01:06 What you would do is if you put an NG tube, you would hook that up to wall suction.

01:10 So essentially, what you will be doing is you’d be helping relieve some of that obstruction.

01:14 For some patients, it definitely does anecdotally make them feel a lot better.

01:18 So when I’m taking care of patients with a bowel obstruction, sometimes they report that an NG tube makes them feel a lot better because it decreases some of that fluid build-up.

01:28 Lastly, you wanna think about giving empiric antibiotics.

01:32 That would be coverage against gram negative as well as anaerobic flora.

01:36 For the most part, those wanna be used for patients who have perforations.

01:40 So patients who their bowel wall got so ischemic with decreased blood flow that it ruptured and that’s definitely you wanna make sure you give those patients empiric antibiotics.

01:52 Also, for patients who are going for operative management.

01:54 Now, who in fact goes for operative management for bowel obstruction, for small bowel obstruction? This is for patients who have perforation.

02:04 That’s an obvious kind of an indication, right? You have a hole in your bowel.

02:08 You’re spilling your intestinal contents into your abdominal cavity.

02:11 That’s a surgical emergency.

02:13 That patient needs to get to the operating room immediately.

02:16 Strangulation of the bowel is when there is a portion of the bowel in which the blood supply is cut off.

02:22 Those patients also have a surgical emergency.

02:25 Time is bowel.

02:26 The sooner you get that relieved, the quicker those patients will feel better.

02:30 And peritonitis and perforation go hand in hand.

02:33 So when you have that perforation, you’re gonna have the bowel contents in the abdomen and that irritation.

02:38 Those patients needs to go emergently to the operating room.

02:42 Again, for the most part, this diagnosis is gonna be based on your imaging study, based on your CT scan, but possibly also on that plain film x-ray.

02:51 What’s the recurrence rate? So are people gonna go for an operation and never have a small bowel obstruction again? That’s definitely not true.

03:00 So certain patients who go for an operation, about 27% of them will actually have a recurrent bowel obstruction at some point.

03:07 Non-operative management though, the recurrence rate is a little bit higher, so it’s about 40%.

03:13 So definitely, this can be a condition that can recur.

03:16 So patients can get repetitive small bowel obstruction.

03:19 Sometimes patients will come in and say, “This feels like when I had a bowel obstruction before.” And more often than not, they’re likely right in when they report that.