Bowel obstruction physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Overview

Patients with bowel obstruction usually appear distressed with a distended abdomen with or without fever. Physical examination of patients with bowel obstruction is usually remarkable for tympanic or hyperresonant abdomen, orthostatic hypotension, tachycardia, and dry mucus membranes.

Physical examination of patients with bowel obstruction is usually remarkable for: Tympanic or hyperresonant abdomen, orthostatic hypotension, tachycardia, and dry mucus membranes.^[1]^[2]^[3]

Patients with bowel obstruction usually appear distressed with sunken eyes.

Abdominal distention
- Tympanic, hyperresonant, bowel sounds are hypoactive and fluid thrill may be present
Abdominal tenderness in the right/left upper/lower abdominal quadrant
A palpable abdominal mass
- May be an abscess, volvulus, hernia, tumor or impacted feces
Abdominal scarrring
- May indicate previous abdominal surgery
Hernia
- Most importanly incisional hernias, also femoral, obturator, umbilical and inguinal hernias that may have strangulated
Peritoneal signs
- Including guarding, tenderness and rebound tenderness
Occult fecal blood
- With rectal exam, blood may be noted, which suggests late strangulation, incarceration or malignancy

↑ Markogiannakis H, Messaris E, Dardamanis D, Pararas N, Tzertzemelis D, Giannopoulos P, Larentzakis A, Lagoudianakis E, Manouras A, Bramis I (2007). "Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome". World J. Gastroenterol. 13 (3): 432–7. PMC 4065900. PMID 17230614.
↑ Catena F, Di Saverio S, Kelly MD, Biffl WL, Ansaloni L, Mandalà V, Velmahos GC, Sartelli M, Tugnoli G, Lupo M, Mandalà S, Pinna AD, Sugarbaker PH, Van Goor H, Moore EE, Jeekel J (2011). "Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2010 Evidence-Based Guidelines of the World Society of Emergency Surgery". World J Emerg Surg. 6: 5. doi:10.1186/1749-7922-6-5. PMC 3037327. PMID 21255429.
↑ Pujahari AK (2016). "Decision Making in Bowel Obstruction: A Review". J Clin Diagn Res. 10 (11): PE07–PE12. doi:10.7860/JCDR/2016/22170.8923. PMC 5198398. PMID 28050445.