Bowel Obstruction - Surgical Students Society of Melbourne
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Transcript Bowel Obstruction - Surgical Students Society of Melbourne
James Zeng
Bowel Obstruction
A blockage of bowel lumen prohibiting the
passage of materials[1]
8% of abdo pain in ED (3rd leading cause)[2]
24% require surgery[3]
300,000 admissions, 800,000 in-pt days,
$1.3bil[4]
Causes
Extrinsic (extraluminal)
Intrinsic (luminal)
Intraluminal
Extrinsic Causes
Adhesions
Hernias
Volvulus
Intrinsic
Neoplastic
Inflammatory
Congenital
Intraluminal
Faeces
Gallstones
Intussception
Bezoar
Bowel Obstruction
Small v. Large
Acute v. subacute
Differential
Paralytic -ileus
Pseudo-obstruction
Constipation
Diagnosis
Clinical
Radiological
Symptoms
Pain
Distension
Obstructive symptoms
Vomiting
Inability to pass motions/slowing
Inability to pass flatus
Past history
Past abdominal surgery
Past obstructions
Hernias
Crohn’s
Malignancy
Signs
Volume status
Scars, volume
Guarding, peritonitis
“Tinkling” bowel sounds, no BS
Hernias
PR
Investigations
Abdo pain bloods
Lactate
Radiology (AxR)
Radiology (AxR)
Large bowel obs
Radiology (AxR)
Size
Walls
Distal collapse
Empty rectum
Radiology (AxR)
Small
Large
Central
Smaller calibre
Valvulae coniventes
More loops
Long fluid levels
Peripheral
Larger calibre
Haustra
1-2 loops
Short fluid levels
Radiology (CT)
Inconclusive XR
Systemically unwell, local peritonitis
Helps to determine cause
>2.5cm with distal collapse
High accuracy
Conservative Management
Fluids
NBM
Analgesia
NG tube
Complications
Electrolytes
Specific Management
Adhesions - conservative ± gastrograffin
Perforation, hernia – urgent theatre
Strictures, colitis – surgical resection
Sigmoid volvulus – rectal tube
Beware of ischaemia – test intraoperatively
Obstruction in Cancer Patients
Various opinions
Depends on when last operation was
Trial of conservative treatment
Gastrograffin/CT
Consider early resection, stent+resection
Non-operative candidates
References
www.medical-dictionary.com
2. Lewis LM et al. Etiology and clinical course of abdominal
pain in senior patients: a prospective, multicenter study.
Gerontol A Biol Sci Med Sci. 2005. 60:8 (1071-6).
3. Foster NM; McGory ML; Zingmond DS; Ko CY. Small
bowel obstruction: a population-based appraisal. J Am
Coll Surg. 2006. 203:2 (170-6).
4. Ray NF; Denton WG; Thamer M; Henderson SC; Perry S.
Abdominal adhesiolysis: inpatient care and expenditures
in the United States in 1994. J Am Coll Surg. 1998. 186:1 (19).
1.