Treatment

A strangulated obstruction is a surgical emergency. In patients with a complete SBO, the risk of strangulation is high and early surgical intervention is warranted. Patients with simple complete obstructions in whom nonoperative trials fail also need surgical treatment but experience no apparent disadvantage to delayed surgery.

Adhesions. Decreasing intraoperative trauma to the peritoneal surfaces can prevent adhesion formation.

Malignant tumor. Obstruction by tumor is usually caused by metastasis. Initial treatment should be nonoperative; surgical resection is recommended when feasible.

Inflammatory bowel disease. To reduce the inflammatory process, treatment generally is nonoperative in combination with high-dose steroids. Consider parenteral treatment for prolonged periods of bowel rest. Undertake surgical treatment, bowel resection, and/or stricturoplasty if nonoperative treatment fails.

Intra-abdominal abscess. CT-guided drainage is usually sufficient to relieve obstruction.

Radiation enteritis. If obstruction follows radiation therapy acutely, nonoperative treatment accompanied by steroids is usually sufficient. If obstruction is a chronic sequel of radiation therapy, surgical treatment is indicated.

Acute postoperative obstruction. This is difficult to diagnose because symptoms often are attributed to incisional pain and postoperative ileus. Treatment should be nonoperative. If nonoperative treatment fails, surgical treatment is indicated.