Small Bowel Obstruction: Causes, Symptoms & Treatment.

Introduction: Small Bowel Obstruction Causes, Symptoms & Treatment. Small bowel obstruction (SBO) can be caused by various factors that obstruct the normal flow of contents through the small intestine. These causes can be broadly categorized into different groups, which are as follows:

Small Bowel Obstruction: Cause: 10 common causes

Small bowel obstruction in adults can result from various causes, often leading to a blockage or obstruction in the small intestine. Common causes include:

Adhesions & Small Bowel Obstruction:

• These are bands of scar tissue that form in the abdomen due to previous surgeries, infections, or inflammation. Adhesions can twist or constrict the small intestine, leading to an obstruction.

Hernias & Small bowel obstruction :

• Hernias are common medical conditions characterized by the protrusion of organs or tissues through weakened muscle walls. They come in two primary forms: external and internal. External hernias are visible and occur outside the body, such as inguinal, incisional, femoral or umbilical hernias. Internal hernias, less common but equally serious, involve organs pushing through abdominal openings, like paraduodenal or obturator hernias. Both types require timely diagnosis and appropriate treatment.

Tumors:

• Both benign and malignant tumors can grow in the small intestine and block the passage of contents. Cancerous tumors can be especially concerning.

Volvulus:

• This is a condition in which a loop of the small intestine twists upon itself, leading to an obstruction. It often occurs in the cecum or sigmoid colon.

Inflammatory Bowel Disease (IBD):

• Conditions like Crohn’s disease can cause inflammation and thickening of the intestinal wall, leading to narrowing and potential obstruction.

Diverticulitis:

• When pouches (diverticula) in the large intestine become inflamed or infected, they can press on the small intestine and cause an obstruction.

Intestinal Tuberculosis :

• These are areas of narrowed or scarred tissue within the small intestine, which can result from conditions like Tuberculosis.

Foreign Bodies:

• Ingesting foreign objects or bezoars (accumulated masses of indigestible material) can block the small intestine.

Impacted Stool:

Severe constipation or the presence of a hard, immovable stool mass can obstruct the small bowel.

Intussusception:

• This is a condition in which one segment of the small intestine telescopes into another, leading to an obstruction.

The medical classification of Small bowel obstruction: 

Medical classification of any disease is categorised in four types: in its due to birth defect ( congenital), due of infection and inflammation of intestine (Inflammatory), if it’s due to cancer ( Neoplastic) or it due to injury (Trauma). So let’s summarise the cusses of small bowel obstruction accordingly.

Congenital:

• Intestinal Atresia: A birth defect where a portion of the intestine is narrow or absent.
• Meckel’s Diverticulum: An abnormal pouch in the small intestine present from birth can sometimes become inflamed or obstructed
• Duplications/Cysts: Abnormal tissue growth within the intestines can lead to blockage.
• Annular Pancreas: 
• Internal Hernia: 

Inflammatory:

• Crohn’s Disease: An inflammatory bowel disease.
• Eosinophilic Granuloma: A condition involving white blood cell buildup in the intestines.
• Infections: Certain infections can cause inflammation leading to obstruction.
• Intra-Abdominal Abscess: Pockets of infection can cause obstruction.
• Tuberculosis: Infections can cause strictures in the intestine.
• Actinomycosis: A rare bacterial infection that can affect the intestines.
• Complicated Diverticulitis: Inflammatory changes can lead to strictures or obstruction.
• Appendicitis: In some cases, inflammation can spread and lead to SBO.

Neoplastic:

• Primary Neoplasms: Cancers originating in the small intestine.
• Metastatic Neoplasms: Cancers from other parts of the body that spread to the small intestine.

Traumatic: 

• Hematoma
• Ischaemic Stricture

Uncommon Intraluminal Obstruction:

• Gallstone: A gallstone can migrate into the intestine.
• Enterolith: Hard masses of undigested material.
• Phytobezoar: A mass of indigestible plant material.
• Parasite Infestation: Some parasites can obstruct the intestine.
• Swallowed Foreign Body: Objects like magnets or sharp items can lead to obstruction.
• Retained surgical items (gossypiboma): 
• Superior mesenteric artery syndrome: 
• Endometriosis: Tissue similar to the lining of the uterus grows in the abdomen.
• Radiation Enteropathy/Stricture: After receiving radiation therapy for cancer in the abdominal region, some individuals may develop inflammation and narrowing of the small intestine.
• Intramural Hematoma: Accumulation of blood within the intestinal wall due to injury.
• Ischemic Stricture: Reduced blood supply can lead to narrowing.

Small bowel obstruction can result from a wide range of conditions, and it’s crucial to identify the underlying cause for appropriate management and treatment. If you suspect an SBO, seek medical attention promptly.

Symptoms of Small Bowel Obstruction 

Small bowel obstruction is a condition where there is a partial or complete blockage in the small intestine. It’s important to recognize the symptoms and seek prompt diagnosis and treatment. Here are the typical symptoms and how it’s diagnosed:

1. Abdominal Pain: Crampy, intermittent abdominal pain is the hallmark symptom. It may start around the belly button and then move to other parts of the abdomen.
2. Vomiting: Due to the obstruction, vomiting is common. Initially, the vomit may contain stomach contents, but as the obstruction continues, it can become bilious (green or yellow).
3. Bloating: Your abdomen may become visibly distended and feel tight.
4. Constipation: You might experience a lack of gas or stool passing through your rectum.
5. Diarrhea: In some cases, you may have bouts of diarrhea due to the accumulation of fluid in the intestine.
6. Loud Bowel Sounds: Doctors may hear high-pitched, tinkling bowel sounds with a stethoscope.

Small Bowel Obstruction Diagnosis:

1. Physical Examination: The doctor will perform a physical exam to assess your abdomen for tenderness, distention, and bowel sounds.
2. Imaging: Various imaging tests can help confirm the diagnosis. These may include:
   • X-rays: An abdominal X-ray can show signs of obstruction, such as air-fluid levels.
   • CT Scan: A computed tomography (CT) scan provides detailed images of the intestines and can help identify the cause and location of the obstruction.
3. Blood Tests: Blood work may be done to check for signs of dehydration or infection.
4. Barium Swallow/Meal: In some cases, you might be asked to swallow a contrast solution that shows up on X-rays to help pinpoint the location of the blockage.
5. Endoscopy: For suspected obstructions in the upper part of the small intestine, an endoscopy may be used to directly view and potentially treat the obstruction.

Remember, small bowel obstruction is a medical emergency. If you suspect you have these symptoms, seek immediate medical attention. Treatment typically involves hospitalization, intravenous fluids, and sometimes surgery to remove the blockage.

Treatment of Small Bowel Obstruction:

The treatment of small bowel obstruction can involve both medical and surgical approaches. The choice of treatment depends on the severity of the obstruction, its cause, and the patient’s overall condition. Here’s an overview of medical and surgical treatments for small bowel obstruction:

Medical Treatment:

1. Nasogastric (NG) Tube: In less severe cases, a nasogastric tube may be inserted through the nose and into the stomach to relieve pressure and suction out stomach contents and gas, which can help decompress the bowel.
2. Hydration and Electrolyte Correction: Patients are usually given intravenous (IV) fluids to correct dehydration and electrolyte imbalances.
3. Pain Management: Pain medications are administered to alleviate discomfort.
4. Bowel Rest: The patient is kept NPO (nothing by mouth) to allow the bowel to rest.
5. Underlying Cause Treatment: If the obstruction is due to an underlying condition, such as Crohn’s disease or adhesions, specific treatments for these conditions may be initiated.

Surgical Treatment:

1. Exploratory Laparotomy: In cases of complete or severe obstruction, and when medical measures fail, surgery may be required. An exploratory laparotomy is performed to identify the cause and extent of the obstruction. The surgeon will remove the obstacle, repair damaged portions of the intestine, and assess the overall condition of the bowel.
2. Lysis of Adhesions: If adhesions are the cause of the obstruction, the surgeon will separate these fibrous bands.
3. Resection and Anastomosis: If a segment of the bowel is damaged beyond repair, the surgeon may remove that section and reconnect the healthy ends (anastomosis).
4. Bypass Surgery: In some cases, the surgeon might create a bypass around the blocked area, allowing the bowel to function.
5. Stent Placement: Stents can be placed to open up a blocked section of the small intestine. This is often used in patients who are not suitable candidates for surgery.

The treatment plan is determined by the healthcare team based on the individual’s condition and the underlying cause of the obstruction. Early intervention is crucial in severe cases to prevent complications and bowel damage. It’s essential to consult with a medical professional for proper evaluation and management of small bowel obstruction.