Abdominal Pain Syndromes: Small Bowel Obstruction and Ileus

Area of Science:

• Gastroenterology
• Surgical Oncology

Background:

• Small bowel obstruction (SBO) and ileus are frequent surgical concerns for family physicians.
• Adhesions are the leading cause of SBO in adults and children, followed by hernias.
• Postoperative ileus, while common after abdominal surgery, is decreasing due to enhanced recovery protocols.

Purpose of the Study:

• To review the diagnosis and management of small bowel obstruction and ileus.
• To highlight the role of family physicians in managing these conditions.
• To discuss current treatment standards and indications for operative intervention.

Main Methods:

• Literature review of common causes, diagnostic modalities, and treatment strategies for SBO and ileus.
• Emphasis on nonoperative management, including gastric decompression, fluid resuscitation, and oral contrast studies.
• Guidelines for operative intervention in specific patient populations.

Main Results:

• Nonoperative management is the standard for low-risk SBO patients after decompression and resuscitation.
• Oral contrast studies are recommended for nonoperatively managed SBO.
• Operative intervention is indicated for hemodynamic instability, recent surgery, peritonitis, or failure of nonoperative treatment.

Conclusions:

• Effective management of SBO and ileus requires prompt diagnosis and appropriate treatment, often starting with nonoperative measures.
• Enhanced recovery protocols are reducing the incidence of postoperative ileus.
• Family physicians play a crucial consultative role in managing these surgical conditions.