Bowel Obstruction
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James Zeng
description
Bowel Obstruction. James Zeng. Bowel Obstruction. A blockage of bowel lumen prohibiting the passage of materials[1] 8% of abdo pain in ED (3 rd leading cause)[2] 24% require surgery[3] 300,000 admissions, 800,000 in-pt days, $1.3bil[4]. Causes. Extrinsic (extraluminal) - PowerPoint PPT Presentation
Transcript of Bowel Obstruction
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
AdhesionsHerniasVolvulus
Intrinsic
NeoplasticInflammatoryCongenital
Intraluminal
FaecesGallstonesIntussceptionBezoar
Bowel Obstruction
Small v. LargeAcute v. subacute
Differential
Paralytic -ileusPseudo-obstructionConstipation
Diagnosis
ClinicalRadiological
Symptoms
PainDistensionObstructive symptoms
VomitingInability to pass motions/slowingInability to pass flatus
Past history
Past abdominal surgeryPast obstructionsHerniasCrohn’s Malignancy
Signs
Volume statusScars, volumeGuarding, peritonitis“Tinkling” bowel sounds, no BSHerniasPR
Investigations
Abdo pain bloodsLactate
Radiology (AxR)
Radiology (AxR)Large bowel obs
Radiology (AxR)
SizeWallsDistal collapseEmpty rectum
Radiology (AxR)
Small LargeCentralSmaller calibreValvulae coniventesMore loopsLong fluid levels
PeripheralLarger calibreHaustra1-2 loopsShort fluid levels
Radiology (CT)
Inconclusive XRSystemically unwell, local peritonitisHelps to determine cause>2.5cm with distal collapseHigh accuracy
Conservative Management
FluidsNBMAnalgesiaNG tube
ComplicationsElectrolytes
Specific Management
Adhesions - conservative ± gastrograffinPerforation, hernia – urgent theatreStrictures, colitis – surgical resectionSigmoid volvulus – rectal tube
Beware of ischaemia – test intraoperatively
Obstruction in Cancer Patients
Various opinionsDepends on when last operation wasTrial of conservative treatmentGastrograffin/CTConsider early resection,
stent+resection
Non-operative candidates
References1. www.medical-dictionary.com2. 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 (1-9).
