The diagnosis of small bowel obstruction is usually straightforward in the older patient (see ChapiZS). Colicky pain, distention, and vomiting that progresses from gastric contents to bile-stained to feculent are the cardinal features. Prior surgery is still the principal risk factor in this age group, and the physician should conduct a careful search for hernias. A missed hernia can lead to a fatal outcome. The mortality rate for small bowel obstruction in the elderly ranges from 14 to 45 percent. Errors in management most frequently relate to misinterpretation of radiographic studies and excessive delays in operative management. 7
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