Management of small bowel obstruction in adults

NPO: nil per os; NG: nasogastric; CT: computed tomography; SBO: small bowel obstruction; PO: oral administration; KUB: abdominal radiograph.
* Adhesive SBO is caused by intra-abdominal adhesions. Because adhesions cannot be directly seen on any imaging modalities, adhesive SBO is usually a diagnosis of exclusion made by combining a known history of prior abdominal surgery with a lack of other discernible causes of SBO on imaging studies.
¶ When used therapeutically, hypertonic water-soluble contrast agents (eg, Gastrografin) are only indicated for adhesive SBO. Therefore, nonadhesive causes of SBO should be excluded. In addition, Gastrografin is contraindicated during pregnancy and has not been shown to benefit postoperative SBO.
Δ Clinical deterioration can be indicated by fever, tachycardia, increasing abdominal pain or distension, acidosis, or leukocytosis.