Management

Bowel obstruction is an emergency and should be detected and managed early to minimize the risk of bowel perforation and strangulation, and the subsequent development of sepsis. The initial management of bowel obstruction is similar to that of undifferentiated acute abdomen.

• ABCDE approach: Evaluate vital signs, volume status, and the need for invasive monitoring.

• Initial management

  • NPO status

  • Obtain IV access with two large-bore peripheral IVs; simultaneously draw blood for urgent laboratory studies.

  • IV fluid resuscitation

  • Electrolyte repletion as needed

  • Insert a nasogastric tube in patients with recurrent vomiting and/or significant abdominal distention.

• Administer supportive care as needed.

  • Parenteral analgesics

  • Parenteral antiemetics

  • Empiric antibiotics for intraabdominal infections (not routinely recommended for simple bowel obstruction) [8][9]

    • If fever and/or leukocytosis are present [3]

    • For strangulated or perforated bowel obstruction

• Obtain imaging: See “Diagnostics.”

• Definitive management: See “Treatment.”