Bowel obstruction
A mechanical or functional obstruction of the intestines.
Bowel obstruction, or intestinal obstruction, is a blockage—either mechanical or functional—that stops digested material from moving normally through the intestines. It can affect either the small or large bowel. This condition has been recognized for millennia, with descriptions found in the Ebers Papyrus from around 1550 BC and in the writings of Hippocrates.
Signs and symptoms vary by location. Common features include abdominal pain, bloating, vomiting, and an inability to pass gas. In small bowel obstruction, the pain is typically cramping and intermittent, centered in the mid-abdomen, with spasms lasting a few minutes. Vomiting often occurs before constipation. Physical exam may reveal dehydration, a distended abdomen that sounds hollow when tapped, general tenderness, and high-pitched, tinkling bowel sounds. In large bowel obstruction, pain is felt lower in the abdomen, with longer-lasting spasms. Constipation appears earlier, and vomiting is less prominent. Patients may have a history of bloating and narrowing stools before severe symptoms develop. Symptoms can come on quickly with volvulus or more gradually with cancer. Exam findings may include a palpable hernia, lower abdominal distension and tenderness, and a rectal mass. Complications can include dehydration and electrolyte imbalances from vomiting, respiratory difficulty from abdominal pressure on the diaphragm, aspiration of vomit, bowel ischemia, perforation, and sepsis from gut bacteria.
Causes differ between the small and large bowel. For small bowel obstruction, the most common cause is adhesions from previous abdominal surgery, accounting for about three-quarters of cases in developed countries. Other causes include hernias, Crohn’s disease, tumors, intussusception, volvulus, superior mesenteric artery syndrome, ischemic strictures, foreign bodies (such as gallstones or swallowed objects), intestinal atresia, barbed sutures, pseudoobstruction, and urinary retention. After abdominal surgery, the overall incidence of small bowel obstruction from any cause is 9%. For large bowel obstruction, common causes include tumors, diverticulitis, hernias, inflammatory bowel disease, colonic volvulus (sigmoid, cecal, or transverse colon), adhesions, constipation, fecal impaction, fecaloma, colon atresia, intestinal pseudoobstruction, endometriosis, and narcotic-induced obstruction (especially in cance
- affected in 2015
- about 3.2 million cases
- deaths in 2015
- 264,000
- sex distribution
- both sexes equally affected
- age range
- can occur at any age
- common causes (small bowel)
- adhesions and hernias
- common causes (large bowel)
- tumors and volvulus
- surgery needed (small bowel)
- about 25%
Lore & Background
Bowel obstruction presents with abdominal pain, vomiting, bloating, and not passing gas. Small bowel obstruction pain tends to be colicky and central, while large bowel obstruction pain is felt lower in the abdomen with longer spasms. Diagnosis may be made on plain X-rays, but CT scan is more accurate; ultrasound or MRI may help in children or pregnant women. Causes include adhesions, hernias, volvulus, endometriosis, inflammatory bowel disease, appendicitis, tumors, diverticulitis, ischemic bowel, tuberculosis, and intussusception.
Reader's Guide
Bowel obstruction is a significant medical condition requiring prompt diagnosis and management. Mechanical obstruction accounts for about 5 to 15% of cases of severe sudden-onset abdominal pain leading to hospital admission. Treatment typically involves intravenous fluids, nasogastric tube decompression, pain medications, and often antibiotics. About 25% of small bowel obstructions require surgery. Complications can include sepsis, bowel ischemia, and bowel perforation. The condition affects both sexes equally and can occur at any age, with historical documentation dating back to ancient Egypt and Greece.
Did You Know?
- Bowel obstruction has been documented in the Ebers Papyrus of 1550 BC and by Hippocrates.
- Small bowel obstructions are most often due to adhesions and hernias.
- Large bowel obstructions are most often due to tumors and volvulus.
- About 3.2 million cases of bowel obstruction occurred in 2015, resulting in 264,000 deaths.
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