Small bowel obstruction: what a gastroenterologist needs to know.

Area of Science:

• Gastroenterology
• Surgical Gastroenterology

Background:

• Intra-abdominal adhesions and intestinal hernias are primary causes of small bowel obstruction.
• Small bowel diseases are less common causes of obstruction but present diagnostic and therapeutic challenges.

Approach:

• Review focuses on small bowel diseases predisposing to obstruction, detailing diagnostic and treatment challenges.
• Utilizes computed tomography (CT) and magnetic resonance (MR) enterography for improved diagnosis of partial small bowel obstruction.

Key Points:

• Endoscopic balloon dilatation can delay surgery for short, accessible fibrostenotic Crohn's strictures and NSAID diaphragm disease.
• Biologic therapy may decrease surgical necessity in inflammatory small bowel Crohn's disease.
• Surgery is reserved for refractory chronic radiation enteropathy causing obstruction or nutritional issues.

Conclusions:

• Small bowel diseases causing obstruction are difficult to diagnose, often requiring extensive investigations and surgery.
• Biologics and endoscopic balloon dilatation offer options to delay or prevent surgical intervention in select cases.