Small bowel obstruction – towards higher calibre care

Small bowel obstruction (SBO) remains a critical emergency with high morbidity and mortality, often exacerbated by delays in diagnosis and treatment. National audits, including NCEPOD’s Delay in Transit and NASBO, highlight that timely imaging is pivotal in improving outcomes. CT with intravenous contrast is strongly recommended as the definitive diagnostic tool, outperforming plain abdominal radiographs, which demonstrate limited sensitivity and specificity. CT not only confirms obstruction but also identifies life-threatening complications such as closed-loop obstruction, bowel ischaemia and perforation – conditions that necessitate urgent surgical intervention.

Despite clear evidence, practice variation persists, with many hospitals still relying on initial radiographs, causing unnecessary delays and resource use. CT with IV contrast was sufficient to diagnose acute bowel obstruction in 89% of patients whereas abdominal radiographs were sufficient to diagnose acute bowel obstruction in only 32%, thus CT influences critical management decisions. In addition to early CT access, timely senior clinical assessment is essential for appropriate triage and imaging protocol selection. Organisational challenges, including lack of dedicated pathways and reporting delays, further hinder optimal care.

This article advocates for a paradigm shift: prompt CT scanning as standard for suspected SBO, supplemented by non-enhanced acquisitions when ischaemia is suspected. Ultimately, reducing delays in imaging and assessment is crucial, echoing the principle that in SBO management ‘time is bowel.’

To download and read this article as a pdf please sign up to our newsletter.

The content on this page is provided by the individuals concerned and does not represent the views or opinions of RAD Magazine.