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Bowel Obstruction (Small and Large)

Bowel Obstruction (Small and Large) is a topic covered in the 5-Minute Emergency Consult.

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  • Obstruction of normal intestinal flow from mechanical or nonmechanical causes
  • Small-bowel obstruction (SBO):
    • 20% of acute surgical admissions
    • Adhesions: Most common cause (60%)
    • Neoplasms
    • Hernias
    • Strictures: Inflammatory bowel disease
    • Trauma: Bowel wall hematoma
    • Miscellaneous (e.g., ascaris infection)
  • Large-bowel obstruction (LBO):
    • Disease primarily of the elderly
    • Carcinoma (60%)
    • Diverticular disease (20%)
    • Volvulus (5%)
    • Colitis (e.g., ischemic, radiation)
    • Crohn's disease
    • Foreign bodies
  • Functional, nonmechanical:
    • Paralytic ileus (e.g., electrolyte abnormalities, injury)
    • Pseudo-obstruction (i.e., Ogilvie syndrome [e.g., operative and nonoperative trauma] 11%)


  • Obstruction leads to proximal dilatation of intestines due to swallowed air and accumulated GI secretions, leading to increased intraluminal pressures.
  • Retrograde peristalsis causes vomiting.
  • Distended bowel becomes progressively edematous, and additional intestinal secretions cause further distention and 3rd spacing of fluid into the intestinal lumen.
  • Obstruction may lead to intestinal wall ischemia (strangulated obstruction), resulting in increased aerobic and anaerobic bacteria, and methane and hydrogen production. Peritonitis, sepsis, and death may follow.
  • Mortality is 100% in untreated strangulated obstruction, 8% if treated surgically within 36 hr, but 25% if surgery delayed after 36 hr.

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Rosen, Peter, et al., editors. "Bowel Obstruction (Small and Large)." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307668/all/Bowel_Obstruction__Small_and_Large_.
Bowel Obstruction (Small and Large). In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307668/all/Bowel_Obstruction__Small_and_Large_. Accessed April 22, 2019.
Bowel Obstruction (Small and Large). (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307668/all/Bowel_Obstruction__Small_and_Large_
Bowel Obstruction (Small and Large) [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 22]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307668/all/Bowel_Obstruction__Small_and_Large_.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Bowel Obstruction (Small and Large) ID - 307668 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307668/all/Bowel_Obstruction__Small_and_Large_ PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -