Treating Small Bowel Obstruction

How do you treat small bowel obstruction?
We have now had several videos on the small bowel, from the anatomy and physiology of the small intestine right through how we can diagnose small bowel obstruction and use labs and imaging in SBO effectively.
You are now ready to understand treatment.
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Schwartz Principles of Surgery citizensurgeon.co/Schwartz
Fischer's Mastery of Surgery citizensurgeon.co/Mastery
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In this video I start with a clinical case and take you right through how you can approach patients with a bowel obstruction and decide whether surgery is indicated or a non operative approach is possible.
Treatment of small bowel obstruction follows several principles.
These principles include...
Volume resuscitation
Enteral decompression
Deciding on surgery versus non-operative management
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In this video I'm going to take you through these different principles of treating small bowel obstruction.
I'm going to teach out when immediate operation is needed and when a non-operative approach is indicated.
I will show you how we do serial monitoring and what is important to watch out for in your daily history and physical exam.
We're going to talk about procalcitonin and how this can be helpful in understanding bowel compromise in patients presenting with small bowel obstruction.
In addition I'm going to share with you some great literature and a scoring system that can be applied in these patients to help give you a bit more decision making power.
Small bowel obstruction is a common diagnosis in surgery and it's important you have a systematic approach to these patients.
We're going to cover a few clinical cases as well and at the bottom of the description I'll put the answers so you can check yourself!
Check out these AMAZING timestamps and fast forward if you need to:
Start 00:00
What do you do first in treating small bowel obstruction? 02:13
Treatment principles in small bowel obstruction 06:06
Indications for immediate operation in small bowel obstruction 09:11
What is non-operative management of small bowel obstruction 17:09
What is procalcitonin and how is it helpful in SBO? 21:52
Can we predict who will need surgery in SBO? 26:18
What outcomes can we expect in small bowel obstruction? 28:01
REFERENCES
Management SBO UptoDate citizensurgeon.co/uptodateSBO1
Procalcitonin in SBO - Cosse - citizensurgeon.co/procalciton...
Risk of recurrence adhesive SBO - Behman - citizensurgeon.co/AdhesiveSBO
Clinicoradiological score for SBO - Schwenter - citizensurgeon.co/schwenter
SOME FAVORITE READS
The Miracle Morning by Hal Elrod - citizensurgeon.co/MiracleMorning
Atomic Habits by James Clear - citizensurgeon.co/AtomicHabits
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WHO AM I?
I'm Dr. Erik Pearson, FACS and I am a board certified pediatric surgeon living in Las Vegas. I make surgical education videos on all topics in general surgery as well as talks on lifestyle design as a surgeon, book reviews, and studying effectively. I also write a weekly newsletter called the Saturday Six where I identify Six different discoveries of the week. You can get the weekly newsletter by signing up to the CITIZENSURGEON Community!
DISCLAIMER
While my aim is to help educate you for the ward, the surgical ICU, the operating room and your exams remember these videos are not a replacement for your reading, your medical school and residency preparation and most important your own decision making. If you have medical questions definitely consult a medical professional. Good luck and enjoy!
Affiliate Links - There are a few links in the description that may lead to a kickback to me to help support the channel.

[@sandramartin9784]

I had a decade of several bowel obstructions a year. GI could not diagnose so I was given a bunch of medications. My last obstruction was a solid month of vomiting, excruciating pain, no food. Hubby took me to GI again who wrote a script for a hundred percocet and told me to go home. Hubby handed him the script back and insisted he start doing some tests. Hospital did a CT scan, admitted me and scheduled a resection as soon as I was stable. Surgeon said it was a "bad u-turn" and had to come out. Surgery is big, 11-day hospital stay, long recovery but worth it. Wish it could have happened sooner.

[@citizensurgeon]

I’m sorry to hear that and thank you for sharing, sounds like a “kink” in the bowel from adhesive disease, some thing just can’t be fixed with a pill, a knife is needed. Glad to hear that you’re feeling better!

[@chadkosakowski3327]

I’ve had 23 small bowel obstructions since 1995 my last one two weeks ago. I’ve had small bowel removal resection times 3 secondary to a nicked bowel during an emergent appendectomy.

[@jeffreykasbohm7685]

Just stumbled on your website ( had very mildly obstructive loooking pt last night ) ---love the boom, boom, boom delivery of salinet points, rapid workup , decison makig point by point, imaging, conservtive treatmant v. right to OR. Fantastic! Super apprecaited.

[@citizensurgeon]

Awesome, that means a lot and I certainly appreciate the support! Have a bunch more long form content videos coming out covering cancer so should be good! If there is a topic you want to learn about let me know!

[@elisabethpearson6698]

Great content as always!

[@citizensurgeon]

Thank you! Have a awesome Friday!

[@noraclark7677]

I can’t comment on the content of this as it is way beyond me but I am sure it is superb! Impressed as always at your total commitment and dedication to this! Happy weekend!

[@citizensurgeon]

Thanks so much Nora! Week by week spreading knowledge. Hope you are also enjoying a beautiful weekend!

[@noraclark7677]

@@citizensurgeon Thank you. I am enjoying a rainy weekend which is cause for celebration and hopefully a rainy week to come. We have bad wildfires here - one that has taken out 200 homes a few miles away. It has been a stressful week with one evacuation that was just five minutes from my place. That has thankfully now been lifted.

[@user-nr3st8zj7i]

Awesome content… very helpful

[@citizensurgeon]

Excellent! Happy you enjoy it!!

[@citizensurgeon]

Excellent! Happy you enjoy it!!

[@jimmiereid2724]

Good job

[@citizensurgeon]

Thanks so much Jimmi! Glad you enjoyed it!

[@benjaminazumah9833]

Thanks Doc.🙏

[@citizensurgeon]

Absolutely thank you!

[@DrAhmedelfawal]

Thank you sir the video was extremely informative indeed. I just wanted to inquire about pain control from the moment the patient presents to the ER till the surgery is done.

[@citizensurgeon]

Thank you for the question and thoughtful feedback. After the diagnosis is made I feel that nasogastric decompression can provide significant relief and intravenous or per rectal acetaminophen is helpful followed by intravenous opioids if needed. I usually avoid NSAIDS initially as these patients are usually hypovolemic and may be at risk of renal injury.

[@ryanmcgully8716]

Awesome video, keep it up I’ll be looking forward to more surgical cases 👏🏼

[@citizensurgeon]

Excellent, pumped you enjoyed it!

[@aquaticlives2948]

How do i prevent sbo? I use opiates and am having a hard time using the bathroom? I get smo once a month, what can i take or do to prevent?

[@sheliakern7036]

I’ve had complete sbo twice and multiple partial sbos, due to removal of my left ovary in 2005. This caused adhesions. The first time they treated it conservatively. NPO, NG tube, pain meds and iv fluids. They did this for 4 days. They finally decided to go in laparoscopicly to see what was going on. Turns out the adhesion had surrounded the small bowel and cinched it off. Once that was released I made a full recovery. Since then I’ve had partials , which I treat at home, npo with liquid only. It can take from a day to a couple of days to resolve. I know that is I begin to vomit or the pain is to much to handle, I go to the hospital. Can you do a video on partial obstruction. Great video, thanks!

[@batoolhussein3624]

Great as usual 👏🏻 Just in case of intussusception specially in pediatrics as it mostly idiopathic and there is no leading point but surely could be , in such cases what is the role of gastrograffin challenge? If it relieves the obstruction, is there need for further imaging to look for (secondary cause) ? as we usually depend only on US to dx intussusception. And if it fails , do we repeat it? Or go for surgery ? Specially if patient condition stable and no complications developed yet. * the most valuable part to me is the scientific approach to the subject with the mention of the recent updated articles about it 👌✨

[@citizensurgeon]

Intussusception in children is a bit different, if a child is hemodynamically stable without peritonitis a contrast enema is indicated for reduction. If the intussusception is reduced on the first attempt often that child can be discharged from the emergency room following a protocolized recovery. No additional tests necessary unless symptoms return.

[@batoolhussein3624]

Much Thanks for the clear explanation as usual 🙏🏻

[@mickypoole9226]

a racing heart beat as well as horrible pain coming in spasms. And after a couple of days, watery diarrhea to the point of 50 times in a 24 hour period. Incomplete and intermittent volvulus

[@peterrudy9207]

Maybe a colonic irrigation , gravity fed water only .

[@Mybabygurl4ever]

I had a sbo in Jan 2023, and today March 2024 have had 6 surgeries with many complications

[@pamowen3452]

Gastrograffin challenge is traumatic, it was put down my ngt and I then vomited for the next 3 hours around my ngt and then had diarrhea that was out of control. Never again, and my surgeon says I may have another SBO. I had surgery 2 months ago to remove adhesions and it took 4.5 hours and then had 30 feet of small bowel, my entire small bowel internally herniated which was not expected.

[@jordangiono8614]

Please why don’t we add analgesics in conservative management? With NG decompression etc

[@maxperez307]

Hello, for the last 5 months I have on and off episodes (lasting 48 hrs) of abdominal pain (Pain level 10) and vomiting (NO FEVER). Last year I went to the emergency room and the SCAN confirmed that I had bowel obstruction. I was immediately rush to surgery ( Laparoscopy), the surgeon told us that there was no obstruction observed while in surgery or it resolved itself. After this episode, 6 months later, i was in the ER again same symptoms and the SCAN confirmed bowel obstruction, i was admitted to the hospital (no surgery), the bowel obstruction resolved itself. Last week, i was again in the ER again same symptoms and the SCAN confirmed bowel obstruction. I refused to go to the hospital and it seems that the obstruction resolved itself (no pain, no vomiting, eating and drinking) bowel movement is mixed. THE QUESTION IS... how can i prevent future obstructions, this is VERY STRESSFUL . Please let me know if you have advise.

[@Devilsqueen123]

Having same issue

[@mariumnaz5174]

Hi!my baby had intussusception surgery in jan 2023 now she have adhesion sine 7 month .her belly swollen every time pain and weight lose due to we give her low fiber liquid.but we dont under stand what to do.plz guide us

[@MarciaHooley-fr7qj]

Ya know I was born with Extraordinary Toxic Megacolon and Chronic Pseudo Obstruction. Iam now 56 and told I'd never see the age of 30. I have recently contacted the heads of the GI Departments at Cedar Sinai, the Cleveland Clinic, the Mayo clinic and the University of Indiana. When my sister died of a brain aneurysm in 2019 due to a poor diet & smoking, I stopped eating meat, fast food and caffeine and lo & behold, I've HAD NO GASTROINTESTINAL DISTRESS SINCE. Now with an ileostomy most people can't handle raw cashews (I eat those to get SOME protein) and the fruit and spices that I can tolerate. I am on a low protein, high carb, high potassium diet. And yes, with only 3 feet & 9 inches of bowel, I only weigh 100 pounds BUT .I box, swim, go biking and run the treadmill 6 days a week & my quality of life is beautiful! My PCP says I am his first & only short gut patient and he wonders if I've hit on something. Best wishes for you & your wee one 🙏✌️

[@kreck9081]

Wife throwing up thick dark green, major pain in abdomen, went to ER and has sbo… started passing gas but no#2.. released after 5 days but still no # 2 .. what should I do ?

[@citizensurgeon]

Definitely contact the medical and surgical team without hesitation if you’re worried, they know the specifics of your wife’s case and can advise. Good luck I hope she recovers quickly!

[@bluewave7120]

Does laproscopic inguinal hernia repair give you a big risk for sbo?

[@lunarlake1]

I have the same question

[@bluewave7120]

@@lunarlake1 Both open and laproscopic have the sbo & twisted intestinal risk What I want to know is the laproscopic a greater risk?

[@RAHUL-wr4rt]

@@bluewave7120i had laparoscopically appendectomy 7 years ago.. do u think that will cause me obstruction after 7 years???

[@KatherineDePietro-bs9oi]

I was diagnosed with small bowel obstruction but I'm afraid of operation 😢🙏

[@C2V3]

It's been five months, did you undergo surgery? If not, what other options did you choose to start or continue for your health?

[@mrsbreannakroll9428]

Same, I’m sorry

[@mrsbreannakroll9428]

I was diagnosed with prominent bowl. I am having no symptoms except my side nerve, pain in back and pain where my overt is on the left side. Am I gonna have to have surgery?

[@ruthevans1249]

@@mrsbreannakroll9428I’ve had over 20 bowel obstructions and also had both surgeries, adhesions separated and I’ve had a small bowel resection… I have Crohn’s disease. The adhesions surgery was done by key hole and wasn’t too bad pain wise and recovery etc but the resection was done by open surgery because I had to have a large chunk of bowel removed, 52cm, this was awful, recovery was months and 5 years later I’m still not back to “normal” and has left me worse off than before… at least I don’t bung up anymore but I do go the loo between 7 - 20 times per day with acid diarrhoea which burns like crazy. I now also have sever bile acid malabsorption and my body can’t absorb vitamin b12 from my diet so I have to have regular b12 injections…. When I need surgery again (which I honestly think will happen at some point when my Crohn’s flares again) I WANT a bag In my experience they will only do surgery on your bowel when absolutely necessary and I wouldn’t advise having surgery unless it was causing you severe problems

[@sandramartin9784]

Surgery was big but I don't regret it one bit. Suffering those blockages over and over again was way worse in my opinion. All the vomiting caused a hiatal hernia. See the comment above on my experience. Surgery was over 15 years ago and I've been good ever since. Take care and wishing you the best.

[@HHH396]

I was admitted with sbo, had the ng tube and i had the g challege. I started to pass gas and have some diarrhea, was able eat. So they realeased me. Well im the second day out and im starting to have trouble passing gas again and only having small bowel movements. No pain or bloating. Should i go back to the hospital to get checked out or are my bowels just slow to move again?

[@Jdm_fl5]

Same here

[@jimmiereid2724]

Do all sob need sugery

[@citizensurgeon]

Absolutely not, many small bowel obstructions will resolve with bowel rest or a gastrograffin challenge

[@marissasoliman]

Sir how to do it.

[@dabigjokeoftheday]

I dont poop for 3 weeks .till it goes to critical mass then repeat....docs are no help.

[@citizensurgeon]

Sorry to hear that, I’ll put out a video on constiptation and help explain it a bit.