Intestinal Obstruction- Abdominal Examination

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Intestinal Obstruction — Abdominal Examination

Structured clinical findings emphasizing small vs large bowel features, signs of strangulation, and examination tips for surgical assessment.

Distension & vomiting

High-pitched bowel sounds

Surgical emergency

Inspection

Patient may appear dehydrated and uncomfortable, with abdominal distension. Note any scars suggesting previous surgery (adhesions), visible peristalsis (more common in proximal obstruction), hernias, abdominal wall defects, or stoma. Observe respiratory rate and signs of systemic toxicity which may indicate strangulation.

Palpation

Palpation should be gentle. Assess for generalized tenderness, localized peritonism (guarding, rigidity) which suggests strangulation or perforation. Palpate for masses such as obstructed hernia or palpable loops. Assess for percussion tenderness. Document abdominal wall defects and hernial orifices carefully.

Findings suggesting obstruction

Distended, tympanic abdomen with central fullness for small-bowel obstruction; more lower abdominal and colonic distension in large-bowel obstruction.

Signs of strangulation

Fever, tachycardia, marked localized tenderness, peritoneal signs, and systemic toxicity.

Hernia check

Examine inguinal, femoral, umbilical and surgical sites — reducibility, tenderness, and cough impulse.

Dehydration

Dry mucous membranes, reduced skin turgor, hypotension — indicate severity and need for resuscitation.

Percussion

Percussion typically reveals tympany due to gas-filled loops, often more central in SBO and generalized in LBO. Succussion splash may be present on gentle rocking if fluid and gas mix in proximal obstruction. Dull areas may suggest fecal-loaded colon or localized collections/abscess.

Auscultation

Bowel sounds are a key finding: high-pitched tinkling, hyperactive sounds with borborygmi in early mechanical obstruction; decreased or absent sounds in late or ileus stages. Presence of peritoneal rub or absent sounds should raise concern for ischemia or peritonitis.

Special tests & investigations

Digital rectal exam: look for stool in rectum (may be empty in complete distal obstruction). Check for fecal impaction. Nasogastric aspirate may show bilious/enteric content. Urgent abdominal x-ray (erect and supine) and CT abdomen are essential — do not delay imaging in suspected strangulation.

Conclusion

Clinical features are consistent with intestinal obstruction. Differentiate small vs large bowel based on history (vomiting vs constipation), inspection (central vs generalized distension), and auscultation (high-pitched early). Any signs of peritonism, systemic toxicity, or irreducible/strangulated hernia warrant urgent surgical review.

Viva Summary (formal):

The patient presents with features of intestinal obstruction: abdominal distension, vomiting, central tympany, and high-pitched bowel sounds. There are no definitive peritoneal signs at present; however, persistent pain, fever, or localized peritonism would suggest strangulation and require immediate surgical intervention.

Examination Tips (point form):

• Start with vital signs — tachycardia, hypotension, fever indicate severity.
• Inspect for scars and hernias; previous laparotomy strongly suggests adhesive SBO.
• Ask about vomiting pattern: early profuse vomiting suggests proximal obstruction; late vomiting with constipation suggests distal.
• Listen for high-pitched, tinkling bowel sounds early in mechanical obstruction; absent sounds in late stage indicate ileus or advanced disease.
• Check hernial orifices thoroughly — an incarcerated hernia is a common cause of obstruction.
• Perform a focused rectal exam — an empty rectum in complete obstruction supports the diagnosis.
• Resuscitate first — IV fluids, NG decompression, electrolyte correction before definitive management.
• Urgent imaging (upright AXR, CT abdomen) if strangulation suspected — do not delay surgery for imaging if patient is unstable.

Prepared for surgical rounds

Updated: Oct 2025