- Blockage of material from transiting the intestine
- This blockage can be partial or complete. It can be the result of mechanical or functional causes.
- Consider intestinal obstruction in the differential diagnosis of patients presenting with abdominal pain, distention, emesis, and obstipation.
- System(s) affected: gastrointestinal (GI)
If patient is an elderly, consider
- Colonic neoplasm
- Chronic constipation/fecal impaction
- Pseudoobstruction (Ogilvie syndrome)
In young children and infants, consider:
- Pyloric stenosis: infant 3 to 6 weeks of age with postprandial, nonbilious, projectile vomiting
- Intestinal malrotation/volvulus: sudden-onset, bilious vomiting with acute abdomen symptoms
- Hirschsprung disease: failure to pass stool in first days of life, explosive expulsion of gas, and stool after digital rectal exam
- Intussusception: distention, intermittent abdominal pain, currant jelly stools
In gastric bypass patients, consider:
In gastric bypass patients, consider:
- Internal hernia: sudden onset of abdominal pain, vomiting, abdominal distention, and “whirl” sign on CT
Predominant sex: male = female
In the United States: Intestinal obstruction accounts for ~20% of all admissions for acute abdominal conditions.
Etiology and Pathophysiology
- Mechanical bowel obstruction causes distention and accumulation of fluid and gas in bowel lumen.
- Increased intraluminal pressure and peristaltic contractions increases capillary and venous pressure of bowel wall while decreasing absorption and lymphatic drainage. This may lead to bowel ischemia and necrosis if obstruction is prolonged.
- Luminal lesions:
- Stool impaction
- Meconium (newborns)
- Intrinsic lesions:
- Congenital (e.g., atresia and stenosis, imperforate anus, duplications, Meckel diverticulum)
- Trauma: foreign body
- Inflammatory (e.g., Crohn disease, diverticulitis, ulcerative colitis, radiation, toxic ingestions)
- Neoplastic (most common cause of large bowel obstruction in adults)
- Miscellaneous (e.g., endometriosis, pseudomyxoma peritonei)
- Extrinsic lesions
- Masses (e.g., annular pancreas, anomalous vasculature, abscess and hematoma, neoplasm)
- Neuromuscular defect (e.g., megacolon, neuro-/myopathic motility disorders)
Potentially related to underlying etiology
- Previous abdominal and/or pelvic surgery (particularly with open surgical techniques)
- Chronic constipation
- Inflammatory bowel disease
- Ingested foreign bodies: pica
- Diverticular disease
Treat underlying conditions (e.g., tumors and hernias).
There's more to see -- the rest of this topic is available only to subscribers.
Domino, Frank J., et al., editors. "Intestinal Obstruction." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816020/all/Intestinal_Obstruction.
Intestinal Obstruction. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816020/all/Intestinal_Obstruction. Accessed May 28, 2023.
Intestinal Obstruction. (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816020/all/Intestinal_Obstruction
Intestinal Obstruction [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2023 May 28]. Available from: https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816020/all/Intestinal_Obstruction.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Intestinal Obstruction ID - 816020 ED - Domino,Frank J, ED - Baldor,Robert A, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816020/all/Intestinal_Obstruction PB - Wolters Kluwer ET - 27 DB - 5-Minute Clinical Consult DP - Unbound Medicine ER -