Bowel Obstruction

Bowel obstruction is a partial or complete interruption of intestinal flow. The blockage may be mechanical, such as an adhesion or hernia, or functional, as in ileus or pseudo-obstruction. Small-bowel obstruction often produces vomiting early; large-bowel obstruction more often produces marked distension and obstipation, although symptoms overlap. Picture a patient whose abdomen is becoming progressively distended, who is vomiting and passing less flatus. A small bowel movement does not rule out a partial obstruction. The immediate concern is not simply constipation: trapped fluid and gas can dehydrate the patient, increase intraluminal pressure, compromise bowel perfusion, and progress to necrosis, perforation, shock, or sepsis. For the RPN, the clinical task is to recognize the pattern, stop measures that could worsen the obstruction, support perfusion and decompression within orders and local policy, and identify the change from uncomplicated obstruction to possible ischemia or perforation.