Presentation

• Generalised abdominal pain

• Nausea

• Vomiting – is later sign in LBO

• Bowels not open

• Tender, often distended, abdomen

Investigations

• Abdominal Xray (looking for distended bowel loops)

• Erect CXR (looking for perforation)

• CT scan of abdomen/pelvis likely to be necessary

• Bloods – Grp and save + Clotting (for possible theatre later), FBC, U+Es, LFTS, CRP, Amylase and lactate

• Urine dip

• DRE and careful clinical examination of hernial orifices

• Further investigations likely to be senior decision

Management

• ABC

• NBM

• NG tube to aspirate stomach and IV fluids (“drip and suck”) (Refer to NGT Feeding Tubes in Adults, Insertion and Care)

• Urinary catheter – monitor input/output

• DVT prophylaxis

• Often managed conservatively but senior r/v to decide

• Consider oral Gastrografin study as a diagnostic and therapeutic measure. Dose: 100mL as a single dose.

Potential Indications for surgery

• Failed conservative management (lower threshold in virgin abdomen)

• Evidence of perforation

• Peritonitis

• Haemorrhage

• Closed loop obstruction

• Hernia

Presentation

• Generalised abdominal pain

• Nausea

• Vomiting – is later sign in LBO

• Bowels not open

• Tender, often distended, abdomen

Investigations

• Abdominal Xray (looking for distended bowel loops)

• Erect CXR (looking for perforation)

• CT scan of abdomen and pelvis likely to be necessary

• Bloods – Grp and save + Clotting (for possible theatre later), FBC, U+Es, LFTS, CRP, Amylase and lactate

• Urine dip

• DRE

• Further investigations likely to be senior decision

Management

• ABC

• NBM

• NG tube to aspirate stomach and IV fluids (“drip and suck”) (refer to trust guidelines on the management of Nasogastric tubes)

• Urinary catheter – monitor input/output

• DVT prophylaxis

• Often managed conservatively but senior r/v to decide

Potential Indications for surgery

• Colonic distension (>12cm on x-ray)

• Caecal tenderness

• Failed conservative management

• Evidence of perforation

• Peritonitis

• Haemorrhage

• In cases of malignant large bowel obstruction consider colonic stenting.

Causes of large bowel obstruction

• Tumour

• Strictures, e.g., Crohn’s, diverticular disease, ischaemic

• Volvulus

This guideline has been registered with the Trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt, contact a senior colleague or expert. Caution is advised when using guidelines after the review date.

This guideline is for use in Frimley Health NHS Foundation Trust hospitals only. Any use outside this location will not be supported by the Trust and will be at the risk of the individual using it.

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