Intestinal obstruction, a surgical emergency that rewards speed and clear thinking.

It is a blockage of the intestinal lumen that stops the normal passage of food, fluid and gas. It can be mechanical, from a physical block such as adhesions, a hernia or a tumour, or functional, from a bowel that has stopped moving as in paralytic ileus or Ogilvie syndrome. Untreated obstruction can progress to ischaemia, perforation and sepsis.

In the small bowel, adhesions from previous abdominal surgery account for up to three quarters of cases, with hernia and tumour making up most of the remainder. In the large bowel, colorectal cancer is the leading cause, followed by sigmoid volvulus and diverticular disease. In children, intussusception, Hirschsprung disease and malrotation with volvulus are important.

The diagnosis starts with the history and examination, supported by bloods and a plain abdominal X-ray. CT of the abdomen with contrast is the gold-standard investigation - it confirms the diagnosis, identifies the transition point, the cause and any complication such as ischaemia or perforation.

No. Adhesive small bowel obstruction often settles with resuscitation, a nasogastric tube and a water-soluble contrast study over 24 to 48 hours. Surgery is reserved for strangulation, peritonitis, closed-loop obstruction, malignant causes or when conservative care fails.

A self-expanding metal stent placed by an interventional endoscopist through a narrowing in the large bowel, most often from cancer. It relieves the obstruction and either bridges to elective surgery in a safer state or serves as a palliative measure when surgery is not appropriate.

If you develop colicky abdominal pain with vomiting, a swollen tender abdomen, or you stop passing stool and wind, contact your surgical team or attend the emergency department the same day. Early assessment prevents the small chance of a mild recurrence becoming a large one.