Intestinal Obstruction

While severe constipation involves infrequent or hard bowel movements and abdominal discomfort, patients can usually still pass gas (flatus). In contrast, a complete intestinal obstruction causes obstipation, meaning the patient cannot pass either stool or gas. Complete obstructions are also characterized by rapidly worsening crampy abdominal pain, pronounced abdominal distension, and repeated vomiting, which can become bilious (green-yellow) or feculent (foul-smelling). Constipation rarely causes severe distension with intractable vomiting. What is the standard initial nonsurgical management for a partial bowel obstruction?::Partial small bowel obstructions caused by post-surgical adhesions are frequently managed conservatively in the hospital. The patient is placed on strict bowel rest (nothing by mouth), given intravenous fluids and electrolytes to correct dehydration, and often has a nasogastric (NG) tube inserted through the nose into the stomach. The NG tube continuously suctions out swallowed air and accumulated digestive fluids, decompressing the swollen intestines, relieving nausea, and giving the bowel space to resolve the partial kink or blockage spontaneously over 24 to 72 hours. What warning signs suggest that an intestinal obstruction has become strangulated?::Strangulation happens when an obstruction cuts off blood supply to a segment of the bowel, leading to tissue ischemia, necrosis, and perforation. Warning signs include a sudden shift from intermittent cramping pain to constant, severe, localized abdominal pain; fever; rapid heart rate (tachycardia); abdominal wall rigidity or involuntary guarding; and elevated white blood cell counts or rising blood lactate levels. Strangulation is a life-threatening surgical emergency that requires immediate operative repair.