Small bowel obstructions kill Marylanders and are often misdiagnosed. Protect yourself and your loved ones.

Small bowel obstruction or SBO gives rise to many Maryland mistaken diagnoses and concomitant wrongful death and medical negligence actions.

The reasons for this tragic phenomenon are numerous and start with the fact that the name "small bowel" is a clear misnomer. The small bowel is typically as long as twenty two feet. Far longer than the equally misnamed large bowel, which while wider is more typically five feet or so in length

The role of the small bowel in the digestive process  is a vital one and its length and width present some diagnostic problems. An organ of such length with many twists and turns and a lesser width is often susceptible to being blocked or "strangulated", typically due to adhesions or tissue scars resulting from abdominal surgery. Other causes of strangulation include hernias, cancer malignancies and Crohn's disease.

The small bowel nears the end of the digestive process and consequently its symptoms and presentation are variable and confuse medical professionals more often than they would care to admit. This is because SBO can manifest itself through vomiting, diarrhea, nausea and constipation, often accompanied by fever.

Obviously a disease process that can effect the human body at opposite ends can be perplexing. Logically one would think that an SBO might cause things eaten to come back up as vomitus but why would it cause seemingly opposite effects such as diarrhea and constipation at the other end? 

The answer is that SBO can be incomplete and also that different symptoms occur at different times in the process of the disease. Consequently misdiagnosis or mistaken diagnosis is common and the use of imaging studies in addition to close examination is essential. 

Abdominal x-rays can be useful but at Clark and Steinhorn, we have seen cases where the x-ray was insufficient to correctly diagnose SBO and reliance on them proved fatal to the patient. MRIs are better and ultrasound can be useful but an abdominal CT scan, particularly CT enterography, is preferable.

Once a diagnosis of SBO has been arrived at surgery is inevitable along with placement of a nasogastric tube to deal with vomiting and antibiotics and fluid replacementare necessary.

SBO is often misdiagnosed as a host of other disease processes including appendicitis, inflammatory bowel disease, diverticular disease and urinary tract infection. In order to protect yourself, a family member or friend be sure that your health care providers are provided a detailed and accurate history and insist that SBO be a major part of the diiferential diagnosis that they are contemplating as a failure to do so can be deadly.