Abdominal Pain Syndromes: Small Bowel Obstruction and Ileus

Small bowel obstruction and ileus are common surgical concerns that family physicians may encounter in a consultative role with surgical specialties. The most common cause of small bowel obstruction in adults and children is adhesions, followed by internal and external hernias. Postoperative ileus is a common complication that can occur after any abdominal surgery; however, with the implementation of enhanced recovery after surgery protocols, the incidence is decreasing. For small bowel obstruction, treatment focuses on gastric decompression, fluid resuscitation, electrolyte replacement, and pain control, which may include opioid therapy initially. Use of oral contrast medium studies for small bowel obstructions managed nonoperatively is now considered the standard of care after appropriate decompression and fluid resuscitation in the low-risk patient. Operative management is recommended for patients with hemodynamic instability, surgery in the previous 6 weeks, or signs of peritonitis, and for those in whom the condition does not resolve with an initial nonoperative approach. Treatment of postoperative ileus is largely supportive, entailing electrolyte correction, intravenous fluids as needed, and pain control.