Bowel Obstruction & Complicated Hernias
Distinguish mechanical obstruction from ileus and identify strangulation before irreversible bowel injury develops.
Quick revision ↓ Medical Dictionary
01Recognise the obstructive syndrome
Colicky pain, vomiting, distension and reduced passage of stool or flatus suggest obstruction, but the pattern depends on level and completeness. Early or partial obstruction can still allow stool passage. Ask about prior surgery, hernias, malignancy and inflammatory disease. Examine scars and hernial orifices, and assess hydration and perfusion. Bowel sounds alone are unreliable for deciding whether obstruction is present or how severe it is.
02Identify threatened bowel
Continuous severe pain, focal tenderness, peritonism, fever, tachycardia or metabolic deterioration raises concern for ischaemia or perforation. A closed-loop obstruction can compromise blood supply rapidly. Normal lactate does not exclude early bowel ischaemia. These findings require urgent surgical assessment rather than prolonged conservative treatment based only on a previous episode that resolved without intervention.
03Resuscitate and define the cause
Keep intake and decompression plans appropriate to aspiration risk and the clinical pathway. Replace losses, monitor electrolytes and urine output, and provide analgesia. CT in a suitable patient can identify transition points, cause and complications. Selected adhesive obstruction may be managed conservatively with close review, sometimes using a water-soluble contrast pathway; this is unsuitable when peritonitis, strangulation or another operative indication is suspected.
04Differentiate hernia complications
A reducible hernia returns its contents, an incarcerated hernia is irreducible, and a strangulated hernia has compromised blood supply. A painful tender irreducible swelling with obstruction or systemic illness is urgent. Do not attempt forceful unsupervised reduction when strangulation is possible. Femoral hernias have an important complication risk and can be subtle, so groin examination matters even when abdominal symptoms dominate.
05Plan definitive and continuing care
The decision to operate considers physiology, imaging, cause and progress. Explain possible bowel resection or stoma when relevant, without promising a single outcome before exploration. After recovery, review recurrence prevention, hernia repair planning and nutritional or oncological needs. Provide warning symptoms and a route to urgent reassessment rather than assuming another episode will behave like the last.
High-Yield Revision
- Passing stool does not exclude early or partial obstruction.
- Continuous pain and peritonism suggest compromised bowel.
- Conservative care requires explicit review and rescue criteria.
Common Pitfalls
- Do not use normal lactate to exclude early ischaemia.
- Do not force reduction of a potentially strangulated hernia.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 27 September 2026. Consult current local protocols for prescribing, procedures and escalation.