Most surgeons favor early laparotomy, although often it is delayed 2 or 3 h to improve the status and obtain a urine output in a very ill, dehydrated patient. An inlying bladder catheter helps monitor urinary output. In cases of repeated vomiting, serum Na and K are likely to be depleted and must be replaced. Fluid balance charts must be maintained continuously, and serum electrolytes should be determined at least daily. In dehydrated patients, a central venous pressure line is helpful.
Surgery removes the offending lesion whenever possible.
Procedures to prevent recurrence should be performed, including repair of hernias, removal of foreign bodies, and complete lysis of adhesions. More often, these are removed by enterotomy at laparotomy. Disseminated intraperitoneal cancer involving the small bowel is a major cause of death from intestinal obstruction in adults. Any attempt to bypass an obstruction is likely to help only briefly. Nasogastric suction, IV fluids and electrolytes, and a urinary catheter are needed before emergency operation.