Intestinal obstruction and pseudo-obstruction

Identifying the etiology of abdominal pain, nausea, and vomiting often remains a challenge for clinicians. A laundry list of etiologies exists for these symptoms including acute gastroenteritis, peptic ulcer disease, metabolic etiologies, medication effects, gastroparesis, mechanical obstruction, and pseudo - obstruction. This review focuses on the diagnosis and management of intestinal mechanical obstruction, intestinal pseudo - obstruction, and differentiating the two. Early identifi cation of complete mechanical obstruction and/or the presence of intestinal ischemia or peritonitis is paramount, as these patients benefi t from early surgical intervention. Most patients with partial bowel obstruction may be managed medically. Clinical recognition of intestinal pseudo - obstruction avoids unnecessary surgery and directs treatment towards symptomatic management. The role of newer imaging techniques, CT and MR radiography and other, newer diagnostic techniques in intestinal pseudo - obstruction is also reviewed.