Bowel obstruction physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Patients with bowel obstruction usually appear distressed with a distended abdomen with or without fever. Physical examination of patients with bowel obstruction is usually remarkable for tympanic or hyperresonant abdomen, orthostatic hypotension, tachycardia, and dry mucus membranes.

Physical examination of patients with bowel obstruction is usually remarkable for: Tympanic or hyperresonant abdomen, orthostatic hypotension, tachycardia, and dry mucus membranes.^[1][2][3]

Patients with bowel obstruction usually appear distressed with sunken eyes.

• High-grade fever
  • May indicate an infection such as the presence of an abscess, ischemia or necrosis
• Tachycardia with regular pulse
  • May indicate dehydration
• Low blood pressure with narrow pulse pressure
  • Dehydration may lead to orthostatic hypotension and a decreased urine output

• Dry mucous membranes
  • May indicate severe dehydration

• Abdominal distention
  • Tympanic, hyperresonant, bowel sounds are hypoactive and fluid thrill may be present
• Abdominal tenderness in the right/left upper/lower abdominal quadrant
• A palpable abdominal mass
  • May be an abscess, volvulus, hernia, tumor or impacted feces
• Abdominal scarrring
  • May indicate previous abdominal surgery
• Hernia
  • Most importanly incisional hernias, also femoral, obturator, umbilical and inguinal hernias that may have strangulated
• Peritoneal signs
  • Including guarding, tenderness and rebound tenderness
• Occult fecal blood
  • With rectal exam, blood may be noted, which suggests late strangulation, incarceration or malignancy

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