Small Bowel Obstruction – Exploratory Laparotomy

Procedure Snapshot

• Indication: Complete or strangulated obstruction unresolved by non-op management.
• Expected duration: ___
• Special instruments: Bowel clamps, lap pads, suction.

Step Workflow

1. Midline incision; protect bowel from injury when distended.
2. Decompress proximal bowel (if necessary).
3. Run bowel from ligament of Treitz to ICV.
4. Identify transition point; release adhesion or volvulus.
5. Assess viability; resect non-viable segments.

Key Pimp Questions

• Q: Most common cause? Post-op adhesions (~65%) (PMID 30566054).
• Q: Viability signs? Peristalsis, color, arterial pulsation.

Critical Anatomy

• Landmarks: Treitz to ICV path.
• Danger zones: Mesenteric vasculature.

Informed Consent Highlights

• Risks: Leak, short-bowel syndrome, recurrence.

Post-op Considerations

• NGT decompression until flatus; early ambulation.

References

• Chassin’s, Small Bowel. Clinical Scenarios, SBO.
• Ten Broek 2018 (PMID 30566054).