Surgical management of small bowel obstruction: What you need to know

Abstract

Small bowel obstruction management has undergone a paradigm shift over the past decade. Surgical dictum had taught us to never let the “sun rise or set on a small bowel obstruction.” We have subsequently learned that a nuanced approach to this disease using practice management guidelines to drive our clinical decision making must be taken. In this review, we will delve into the process of deciding who needs an urgent/emergent operation versus observing a patient on the ward. We will also discuss how long to wait until an exploration should be performed for those patients initially undergoing non-operative management, and, once in the operating room, the fundamental techniques and newer approaches which should be in surgeon’s armamentarium. Lastly, we will highlight the approach to less common causes of small bowel obstruction including malignant bowel obstruction, virgin abdomens, and Crohn’s disease.