Editing Small bowel obstruction (section)

=== '''Non-operative management''' ===

* NBM + ice chips for comfort
* NGT 14 or 16Fr (check position ASAP to allow Gastrografin)
* IVF and electrolyte replacement
* Consider IDC
* Rationalise medications
* Antibiotics only if surgery is required
* Gastrografin given once outputs have settled to the point where it's safe to spigot NGT for 4-5 hours
** Note that '''GG does not increase the proportion of patients that avoid an operation''', but does decrease time to resolution (in patients that would have resolved anyway) and hospital stay. There is not strong evidence that it acts therapeutically.
** 100mL Gastrografin neat then spigot NGT until either patient opens bowels or patient has refractory nausea
** If no contrast in colon in 24/36hrs - surgery
*** Presence of GG in colon at 24 hours predicts non-op resolution with 97% specificity and 96% sensitivity
** Schein suggests give it 1-2 hours after NGT decompression