🔪 General SurgeryGastrointestinal / EmergencyStudentInternResident

Intestinal Obstruction

Also known as: bowel obstruction · acute abdomen · ileus

Blockage of the bowel — colicky abdominal pain, vomiting, distension and absolute constipation (no flatus or stool). Small-bowel obstruction is often adhesions or hernia; large-bowel is often malignancy or volvulus. The danger is strangulation.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

Previous surgery (adhesions), hernias, malignancy, volvulus, and intussusception (children).

Red flags — escalate / refer

Constant (rather than colicky) pain, fever, tachycardia, peritonism, or a tender irreducible hernia → strangulation/ischaemia — a surgical emergency.

Work-up / diagnosis

1Examine the hernial orifices and scars; bloods including lactate (a marker of ischaemia).
2Imaging — abdominal X-ray then CT to confirm the level, the cause, and any ischaemia or perforation.

Management — overview

'Drip and suck' — nil by mouth, IV fluids and a nasogastric tube to decompress, with correction of electrolytes.
Many adhesional small-bowel obstructions settle conservatively.
Operate for strangulation, a closed-loop obstruction, a non-reducing hernia, or failure to resolve; treat the cause (resect a tumour, untwist a volvulus).

In-depthFull dosing & advanced protocol

Drug dosing

IV fluids + electrolyte correction

Resuscitation and 'drip and suck'

Adult dose: Per protocol and losses
Route: Intravenous

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

Analgesia / antiemetic (± antibiotics)

Symptom control; antibiotics if strangulation/perforation

Adult dose: Per protocol
Route: IV

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

Spot strangulation; who needs theatre

A change from colicky to constant pain and a rising lactate suggest strangulation.
Uncomplicated adhesional small-bowel obstruction often resolves with conservative care.
A tender irreducible hernia needs surgery; a sigmoid volvulus may be decompressed endoscopically.

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

More protocols

Acute AppendicitisAcute inflammation of the appendix — the commonest surgical acute abdomen. Classically peri-umbilical pain that migrates to the right iliac fossa. Prompt surgery prevents perforation.Acute Cholecystitis & Biliary ColicInflammation of the gallbladder, usually from an obstructing gallstone — constant right-upper-quadrant pain, fever and a positive Murphy's sign. Biliary colic is transient pain from a stone WITHOUT inflammation.Acute Limb IschaemiaSudden loss of arterial perfusion to a limb — a surgical emergency. The 6 Ps: Pain, Pallor, Pulselessness, Paraesthesia, Paralysis and Perishing cold. Muscle and nerve injury begin within hours.

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👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

IV fluids + electrolyte correction

Analgesia / antiemetic (± antibiotics)

📈 Spot strangulation; who needs theatre

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

IV fluids + electrolyte correction

Analgesia / antiemetic (± antibiotics)

📈 Spot strangulation; who needs theatre

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Spot strangulation; who needs theatre

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Spot strangulation; who needs theatre

References