Small Bowel Obstruction

Dr. Sulaiman Bin Yusof

MbChB (Sheffield) M.Med (Surg) FRCSEd (Gen Surg)
蘇萊曼·尤索夫博士

Small bowel obstruction occurs when the normal flow of digestive contents through the small intestine is blocked, either partially or completely.

This blockage prevents the normal passage of food, fluids, and gas through the intestines, leading to the accumulation of contents above the blocked area. The condition can cause severe abdominal pain and vomiting and, if left untreated, can result in serious complications, including tissue death and perforation of the bowel.

Symptoms of Small Bowel Obstruction

Small bowel obstruction typically presents with a combination of symptoms that develop over hours to days.

Abdominal Pain: Crampy, intermittent pain occurs in waves, typically centred around the navel and may intensify as the obstruction progresses.

Vomiting: The blockage leads to bile-stained vomit, providing temporary relief from nausea. As the obstruction worsens, vomiting can become more frequent and severe.

Abdominal Distension: The abdomen becomes visibly swollen due to the accumulation of gas and fluid above the obstruction, creating a sensation of fullness or tightness.

Absence of Bowel Movements: A complete inability to pass gas or stool indicates a total blockage of the intestinal passage.

Loss of Appetite: Nausea and an inability to tolerate food are common, with even small amounts of liquid or solid food becoming intolerable.

Causes and Risk Factors

Small bowel obstruction can result from a variety of underlying conditions. Common causes include:

  • Adhesions

    Scar tissue bands can form connections between sections of the intestine or other abdominal structures. These adhesions may twist, constrict, or compress the bowel, causing an obstruction.

  • Hernias

    Weak spots in the abdominal wall allow parts of the intestine to protrude, where they may become trapped, restricting blood flow or blocking the passage of intestinal contents.

  • Inflammatory Bowel Disease

    Chronic inflammation, such as Crohn’s disease, can thicken or narrow the bowel wall, disrupting the normal flow of food and waste.

  • Tumours

    Growths, whether cancerous or benign, can obstruct the bowel by compressing it externally or blocking it internally, depending on its location and size.

  • Foreign Bodies

    Ingested objects can become lodged in the small intestine, particularly in areas already narrowed. These may include food particles, non-food items, or gallstones that have entered the intestinal tract.

Types of Small Bowel Obstruction

Small bowel obstruction presents in different forms based on the nature and extent of the blockage.

Mechanical Obstruction

A physical blockage prevents intestinal contents from passing. This occurs when something physically blocks or compresses the bowel lumen, such as adhesions, hernias, or tumours. The blockage can be partial or complete, affecting treatment decisions and urgency.

Functional Obstruction (Ileus)

The bowel loses its normal coordinated muscle contractions. This type occurs due to nerve or muscle problems rather than physical blockage. It often develops after surgery or with certain medications that affect bowel motility.

Strangulating Obstruction

The blood supply to the bowel becomes compromised along with the obstruction. This represents a surgical emergency, as the lack of blood flow can lead to rapid tissue death and bowel perforation within hours.

Diagnostic Methods

Physical Examination

The doctor examines the abdomen for distension, tenderness, and bowel sounds. This initial assessment includes checking for surgical scars, hernias, and signs of peritonitis that may indicate bowel compromise.

X-ray Imaging

Plain abdominal X-rays show dilated loops of small bowel and air-fluid levels characteristic of obstruction. These images help determine the level and severity of the blockage.

CT Scan

Computed tomography provides detailed images of the bowel, identifying the location and cause of obstruction. The scan can also show complications like perforation or compromised blood supply.

Blood Tests

Laboratory studies assess for dehydration, infection, and organ function. These tests help determine the severity of the condition and guide treatment decisions.

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Treatment Options

Non-Surgical Treatment
Bowel Rest

Complete restriction of oral intake allows the bowel to decompress naturally. This approach includes the placement of a nasogastric tube to remove accumulated fluid and gas.

Intravenous Fluids

Fluid therapy corrects dehydration and electrolyte imbalances caused by vomiting and reduced intake. Regular monitoring of fluid status guides the volume and type of fluids needed.

Pain Management

Medications help control abdominal pain while avoiding those that may further slow bowel function. Regular assessment ensures adequate pain control without masking warning signs.

Surgical Treatment
Adhesiolysis

This procedure removes adhesions that are causing the obstruction. The choice between open surgery and minimally invasive laparoscopy depends on the size, extent, and location of the adhesions. Laparoscopy is typically preferred for its smaller incisions and faster recovery.

Bowel Resection

When the bowel’s blood supply is compromised or the tissue is severely damaged, the affected segment of the intestine is surgically removed. The healthy ends are then joined together to restore continuity and function. This procedure is necessary to prevent further complications, such as infection or perforation.

Hernia Repair

Surgical correction of hernias that trap portions of the bowel involves repositioning the trapped intestine and repairing the abdominal wall defect. This repair reduces the risk of recurrence and restores the bowel’s normal function.

Prevention and Management

Prevention focuses on minimising risk factors when possible, particularly in patients with previous abdominal surgery. Early mobilisation after surgery helps prevent adhesion formation. Patients with known hernias should seek repair before complications develop. Those with inflammatory bowel disease require regular monitoring and management of their condition to prevent stricture formation. Regular follow-up allows for early detection and management of potential complications.

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Dr. Sulaiman Bin Yusof

MbChB (Sheffield)

M.Med (Surgery)

FRCSEd (General Surgery)

蘇萊曼·尤索夫博士

Dr. Sulaiman Yusof is a distinguished Senior Consultant in colorectal and general surgery, boasting over 15 years of expertise. His passion lies in minimally invasive techniques, particularly robotic surgery, where he has achieved remarkable success using the Da Vinci Xi system. Dr. Sulaiman is dedicated to delivering high-quality, personalized, and empathetic care, always striving for the best outcomes for his patients.

Education & Specialist Training
  • MbChB(Sheffield)
  • M.Med(Surgery)
  • FRCSEd(General Surgery)

Dr. Sulaiman’s journey began at the University of Sheffield, where he graduated in 2002. He honed his skills during his house officer and basic surgical training in the UK before returning to Singapore. There, he completed his Advanced Surgical Training at Changi General Hospital and earned the Joint Speciality Fellowship in General Surgery in 2013.

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    Gleneagles Medical Centre

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    Singapore 258499

    Mount Elizabeth Novena Hospital

    38 Irrawaddy Road, #10-48/49
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    Frequently Asked Questions

    How long does recovery take after surgical treatment?

    Recovery time varies depending on the procedure performed and whether it was done openly or laparoscopically. Most patients remain in hospital for 5-7 days and require 4-6 weeks for full recovery.

    What diet should be followed after treatment?

    Diet advancement follows a careful progression from clear liquids to a full diet. Each stage requires tolerance before progressing to more substantial foods, typically over several days.

    Can small bowel obstruction recur?

    Yes, particularly in cases caused by adhesions. About 30% of patients may experience another episode within 5 years of the initial occurrence.

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