Intestinal Obstruction: Evaluation and Management

Acute intestinal obstruction occurs when the forward flow of intestinal contents is interrupted or impaired by a mechanical cause. It is most commonly induced by intra-abdominal adhesions, malignancy, and herniation. The clinical presentation generally includes nausea, emesis, colicky abdominal pain, and cessation of passage of flatus and stool, although the severity of these clinical symptoms varies based on the acuity and anatomic level of obstruction. Abdominal distension, tympany to percussion, and high-pitched bowel sounds are classic findings. Laboratory evaluation should include a complete blood count, metabolic panel, and serum lactate level. Imaging with abdominal radiography or computed tomography can confirm the diagnosis and assist in decision making for therapeutic planning. Management of uncomplicated obstructions includes intravenous fluid resuscitation with correction of metabolic derangements, nasogastric decompression, and bowel rest. Patients with fever and leukocytosis should receive antibiotic coverage against gram-negative organisms and anaerobes. Evidence of vascular compromise or perforation, or failure to resolve with adequate nonoperative management is an indication for surgical intervention.