14 Small Bowel Obstruction

Small bowel obstruction (SBO) remains a common con-dition for surgical teams to manage. Despite this, variablepresentations and difficulties in correctly timing appropri-ate surgical intervention give rise to considerable challenges.Balancing conservative treatment against operative, guidedby a range of diagnostic aids with numerous managementoptions, presents a significant clinical dilemma.SBO has been estimated to represent 5% of all acute gen-eral surgical admissions in the United Kingdom, with previ-ously reported mortality rates ranging from 4% in patientsmanaged conservatively to 28% in high-risk groups under-going surgery. The complexity of managing these patientsshould not be underestimated and an absence of high levelevidence to guide this means that many strategies remaincontroversial. An understanding of the underlying patho-physiology, early diagnosis, meticulous fluid balance andclose observation together with timely surgical intervention,if required, are all essential components of a successful out-come.