2. 65 year old White male
presents complaining of
diffuse, crampy abdominal
pain. He began vomiting a
few hours ago and feels very
nauseated. His last bowel
movement was yesterday.
He has a history of an open-
cholecystectomy and open -
appendectomy.
T: 98.9 P 110 R 16 BP 120/80
Gen: elderly male in NAD,
HEENT: PERRL, NCAT,
Oropharynx clear
CV: mildly tachycardic, No m/r/g
Pulm: CTAB
Abd: active, high-pitched bowel
sounds; mild TTP diffusely, No
rebound/guarding; mild
distention
Ext: 2+ pulse, no c/c/e
3.
4. 1. Air Fluid Levels
2. String of Pearls Sign
1. small, round air pockets
trapped in plicae circulares
(valvulae conniventes) of
small intestine
3. Dilated Bowel >3cm
1. Rule of 3,6,9
4. Coiled Spring Sign
5. Plicae Circulares
(Valvulae Conniventes)
1. Indicates Small Bowel
involved
6. No gas in colon
1. Indicates Small Bowel
involved
5. Most common causes: (1) surgical adhesions (2)
Hernia (3) Tumor (4) Inflammatory Bowel Disease
(5) Intussusception (6) Gallstone Ileus
Rule of 3,6,9:
suspect obstruction if small bowel dilated >3cm; large bowel >6cm,
cecum >9cm.
“Never Let the Sun Rise or Set on a Small Bowel
Obstruction”
6. IV & IVFs
NG Decompression
Analgesics and Antiemetics
Surgery Consult
Approximately one-quarter of patients admitted for small
bowel obstruction will require operation.
Patients suspected of having complete or closed-loop
obstruction with fever, leukocytosis, tachycardia, metabolic
acidosis, continuous pain or peritonitis warrant prompt
exploration
Antibiotics are suggested if surgery planned.
Admission to hospital
Medical service is reasonable disposition if patient does not
have significant risk factors for surgical managment
7. String of Pearls Sign = obstruction
Small Bowel: air pockets trapped in valvulae of small intestine, smaller,
rounder
Large Bowel: air pockets trapped in haustra; larger, and have flat
underside
Large
Bowel
Small
Bowel
8. • Coiled Spring Sign:
•Dilated coils of small bowel
that appear stacked
•Indicates SBO
• Slit sign:
• Caused by small amounts
of air caught in the valvulae
of fluid-filled bowel that
appear as “slits of air”
• Similar to string of pearls
sign
• Indicates SBO