Snapshot A 65-year-old women presents with diffuse abdominal pain, and vomiting. She has not had a bowel movement in three days. PE reveals hyperstasis, tympany to percussion, no rebound tenderness, and a temperature of 38. AXR reveals distended loops of bowel with a step ladder pattern of differential air-fluid levels. Introduction Most common surgical problem of small bowel Causes include adhesions from previous surgeries (most common cause of all bowel obstructions) hernias neoplasms Presentation Symptoms crampy abdominal pain lack of flatus / constipation nausea/vomiting Physical exam abdominal distention high pitched "tinkly" bowel sounds, but as SBO worsens can become muffled and even hypoactive until no bowel sounds heard with significant obstruction tenderness hernias Evaluation Abdominal radiograph dilated loops of small bowel with continuous circular folds ladder like appearance air-fluid levels Consider water soluble contrast (gastrograffin) can reduce edema and increase peristalsis Differential Pseudo-obstruction (Ogilvie's Syndrome), Paralytic ileus Treatment Hospitalize IV fluids Nasogastric decompression NPO Surgery