Guideline / position statementindependent cross-checkfull text checked★ key study I-INTC-05 in-depth review
What causes a blocked small intestine
Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group.
Overview
Ten Broek RPG et al.. World J Emerg Surg 2018 · PMID 29946347 · DOI 10.1186/s13017-018-0185-2
A blocked bowel is an emergency with pain, vomiting and swelling; it is usually caused by scar tissue after surgery, hernias or tumours.
Does the study support the specific claim? No · Methodological quality: high
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Guide diagnosis and treatment of adhesive bowel obstruction
- How was the study done?
Evidence-based guideline
- How many people, animals or samples were studied?
Patients with obstruction
- What was actually found?
Adhesions are the most common cause; bezoars are infrequent
- How large was the observed effect?
51% of UK emergency laparotomies were for bowel obstruction
- What do the results mean in everyday life?
Bowel obstruction is a serious emergency, not an everyday result of eating bread or noodles.
- What are the study's limitations?
Not designed to study diet
- What does it say about Elawady's specific claim?
Contradicts 'recurrent obstruction from ordinary food'
- Do the results apply to Germany and Europe?
High
- What can explicitly not be concluded from this study?
Rare food-related obstructions in people with risk factors
Scientific in-depth review
1. Full reference
- Authors
- Ten Broek RPG et al.
- Journal
- World J Emerg Surg
- Year
- 2018
- Identifier
- PMID 29946347 DOI 10.1186/s13017-018-0185-2
- Verification
- verified – PubMed efetch 2026-10-25; full text via Europe PMC fullTextXML PMC6006983
- Retracted
- no
- Corrections
- none
- Extent checked
- full text
- Conflicts of interest and funding
Authors declare no competing interests.
2. Research question
How should adhesive small bowel obstruction be diagnosed, treated and prevented?
3. Study design and population
- Study design
- Guideline / position statement – Evidence-based guideline (World Society of Emergency Surgery) with systematic literature search
- Population
Patients with small bowel obstruction
- Country
International
- Period
Literature search before 2017 update
- Sample size
not applicable
- Inclusion and exclusion criteria
Systematic literature search; evidence-based guideline method
4. Methods and endpoints
- Exposure / intervention
Adhesive small bowel obstruction
- Comparator
not applicable
- Endpoints
Diagnosis, treatment, prevention
- Statistical methods
Levels of evidence and recommendation grades
5. Actual results
- Results
Full text (PMC6006983, read 2026-10-25): small bowel obstruction is a surgical emergency characterised by abdominal pain, vomiting, distention and constipation; adhesions, typically the footprints of previous abdominal surgery, are the single most common cause; non-adhesive causes include incarcerated hernias, obstructive lesions (malignant and benign) and infrequent causes such as bezoars, inflammatory bowel disease and volvulus; in the UK small bowel obstruction was the indication for 51% of emergency laparotomies. Abstract: CT is the diagnostic technique of choice when the cause is unsure; non-operative treatment is effective in most patients.
- Absolute risks
not reported
- Authors' conclusion
Recommendations for surgeons; evidence is scarce for some aspects.
6. Strengths
- Systematic search
- International expert group
- Full text read for aetiology passages
7. Weaknesses
- Some recommendations based on limited evidence
8. Risk of bias
- Orienting tool
- AMSTAR 2
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Guideline based on systematic search; not formally appraised (formal: false).
9. Assessment of the statistical interpretation
Descriptive; 51% figure refers to UK emergency laparotomies.
10. Relevance to the specific claim
Describes what a real bowel obstruction is (an emergency with clear symptoms) and its causes (mainly post-surgical adhesions, hernias, tumours; bezoars are infrequent). Normal meals such as flour or instant noodles are not listed as causes.
11. Independent contrary findings
None.
12. Transferability to Germany and Europe
Applicable; European authors.
13. Overall methodological judgement
Authoritative source on the definition and causes of small bowel obstruction.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | high |
| Risk of bias | some concerns |
| Precision of results | not applicable |
| Directness | indirect |
| Reproducibility | replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Incidence of food-related obstruction in people without risk factors.
15. Linked fact checks
- Hard-to-digest foods (for example two spoons of flour) cause repeated, incomplete intestinal obstructions lasting days, which drive insulin 'sky-high' and cause obesity and inflammation. – Studies contradicting or limiting the claim
- Food that is not chewed well is not fully digested in the stomach, and this incomplete digestion leads to intestinal obstruction. – Studies contradicting or limiting the claim
- Instant noodles ('Indomie') and processed foods cause sudden spikes in intra-abdominal pressure and serious problems such as intestinal obstruction. – Studies contradicting or limiting the claim