IV fluid resuscitation with electrolyte repletion
Assessment of need for operative vs nonoperative management
14 French
Intermittent low wall suction
Nasogastric fluid losses can be replaced with NS + KCL (30-40 meq)
There is some evidence to suggest nasogastric tube decompression was not associated with decreased bowel ischemia or need for surgery
Intermittent low wall suction
Both diagnostic and therapeutic (draws water into the bowel stimulating peristalsis)
Associated with decreased hospital stay, more rapid resolution of symptoms
Repeat CT scan may be helpful to detect early signs of bowel ischemia
Repeat plain films are not helpful (only detect perforation)
Repeat plain films are not helpful (only detect perforation)
Alternative to operative management if early obstructive process
Gastrografin through NG or OG decreases bowel wall edema and increases bowel motility
Diagnostic and therapeutic
100 cc of gastrografin through NG tube
Transit may be observed through serial radiographs
Contrast within the large bowel within 24 hrs suggest partial<unk> 
Contrast failing to reach large bowel within 24-48 hrs suggests complete obstruction, requiring laparotomy
Therapeutic, may reduce necessary operative rate by ~75%
Avoid barium as it becomes inspissated in bowel, causing complete obstruction
Gastrografin is water-soluble and relatively safer if perforation occurs
Diagnostic and therapeutic
100 cc of gastrografin through NG tube
Transit may be observed through serial radiographs
Contrast within the large bowel within 24 hrs suggest partial<unk> 
Contrast failing to reach large bowel within 24-48 hrs suggests complete obstruction, requiring laparotomy
Therapeutic, may reduce necessary operative rate by ~75%
Contrast within the large bowel within 24 hrs suggest partial<unk> 
Contrast failing to reach large bowel within 24-48 hrs suggests complete obstruction, requiring laparotomy
Gastrografin is water-soluble and relatively safer if perforation occurs
75% of patients are amenable to non-operative management
25% of patients admitted for<unk>  require surgery
Surgery is indicated for patients with:
Increasing pain, distention, or peristent high NGT output
Necrotic bowel
Closed-loop obstruction (incarcerated hernia,<unk>  bowel volvulus, cecal volvulus)
Fever, leukocytosis, peritonitis
Increasing pain, distention, or peristent high NGT output
Necrotic bowel
Closed-loop obstruction (incarcerated hernia,<unk>  bowel volvulus, cecal volvulus)
Fever, leukocytosis, peritonitis
Not typically indicated, unless evidence of concurrent ischemia or infection
See peritonitis antibiotics
Small bowel obstruction
Abdominal aortic aneurysm
Large bowel obstruction
Aortocaval fistula
Malignant bowel obstruction
Acute gastroenteritis
Epiploic appendagitis
Aortoenteric fisulta