Snapshot A 50-year-old woman presents to the emergency room for nausea, vomiting, loss of appetite, and abdominal pain. She has a history of Crohn disease, on infliximab, but she reports that this did not feel like a flare of her disease. On physical exam, there is tenderness to palpation of her abdomen without any peritoneal signs. An abdominal radiograph shows dilated loops of small bowel. She is started on intravenous fluids, given anti-emetics, and put on bowel rest. Introduction Overview partial or complete blockage of the small intestines Epidemiology incidence common risk factors prior abdominal surgeries (most common) post-operative adhesions masses/malignancy hernias inflammatory bowel disease intussusception (in children) Prognosis partial SBOs often self-resolve complete SBOs may also self-resolve but often require surgical intervention Presentation History decreased appetite lack of flatus constipation Symptoms common symptoms nausea and vomiting abdominal pain Physical exam inspection abdominal distention motion generalized tenderness to palpation Imaging Abdominal radiographs indications best initial test findings dilated loops of small bowel free air may indicate need for immediate surgery Computed tomography (CT) of abdomen and pelvis indications diagnosis of SBO findings dilated loops of small bowel transition point any masses present Studies Serum labs lactic acid to monitor for bowel necrosis if suspected Invasive studies small bowel follow-through with gastrograffin indication patients who fail to improve clinically after 48 hours of nonoperative treatment may rule out need for surgery Differential Appendicitis distinguishing factor imaging shows enlarged appendix with signs of inflammation instead of dilated loops of bowel with transition point Treatment Conservative and lifestyle supportive care modalities intravenous fluids Medical and pharmacologic treat underlying condition nasogastric decompression and bowel rest indications partial SBO no signs concerning for bowel strangulation Surgical and interventional surgical intervention with correction of cause of SBO (i.e., lysis of adhesions) indications peritonitis signs concerning for bowel strangulation systemic signs (i.e., fever) metabolic acidosis continuous pain Complications Bowel necrosis Peritonitis Bowel perforation